Free CNOR Practice Test: 50 Questions With Answers and Rationales
This free CNOR practice test has 50 original questions, each with an explanation for every answer choice and a source you can check. It's unofficial—not a full-length exam—and follows CCI's current seven-area outline, with no signup (what changes in 2027).
Practice questions
Question 1 of 50
Assessment and diagnosis · CNOR-001
An awake adult scheduled for elective right knee arthroscopy tells the circulating nurse during the preoperative interview, "They're fixing my left knee today." The signed consent and the OR schedule both say right knee. No sedation has been given. What should the nurse do next?
- A. Pause preparation and notify the surgeon so the site can be resolved.
- B. Continue preparing the right knee because the signed consent is the legal record.
- C. Correct the consent to the left knee, since the patient knows which knee hurts.
- D. Keep preparing and bring up the question during the time-out.
Show answer and explanation
Correct answer: A. The whole point of pre-procedure verification is to confirm the correct procedure, patient, and site, with the patient involved when possible. A patient who contradicts the paperwork means the site is not verified. The accountable surgeon needs to resolve it before the case moves forward.
Why the other choices don't fit
- B: A signed form does not settle a conflict with what the patient is telling you. Until the discrepancy is resolved, you do not know which record is wrong.
- C: Changing the consent to match this statement would not resolve the discrepancy. Both sources need to be reconciled by the surgeon.
- D: The time-out is the final check, not the place to park a discrepancy you already know about. Preparation would continue on a site that may be wrong.
Takeaway: A known site discrepancy stops the line until the accountable surgeon resolves it.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.01.06.01, EP 1 (p. 5).
Question 2 of 50
Intraoperative patient care and safety · CNOR-013
Only one medication, a local anesthetic, will be used on the sterile field. The scrub person draws it into a syringe that will be used later in the case. The surgeon says a label isn't needed because nothing else is on the field. What is correct?
- A. No label is needed as long as the scrub person keeps the syringe in hand.
- B. Label it only if a second medication is added to the field.
- C. Label the syringe as soon as the medication is drawn up.
- D. Write the drug name on the back-table cover next to the syringe.
Show answer and explanation
Correct answer: C. In perioperative settings, Joint Commission requires labeling of medications and solutions, on and off the sterile field, that are not immediately administered, even if only one medication is being used. Labeling also happens whenever a medication is transferred from its original packaging into another container.
Why the other choices don't fit
- A: The requirement has no exception for holding the syringe. Hands change during breaks and relief.
- B: The rule applies even when there is only one medication.
- D: A note on the table is not a label on the container. Syringes get moved.
Takeaway: One medication or ten, if it isn't given immediately, it gets a label.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.14.03.01, EPs 1-2 and 5 (pp. 43-44).
Question 3 of 50
Infection prevention · CNOR-035
A reusable laparoscopic trocar will enter the patient's abdominal cavity. Under the Spaulding classification CDC uses, what is the minimum processing required before use?
- A. High-level disinfection
- B. Intermediate-level disinfection
- C. Low-level disinfection
- D. Sterilization
Show answer and explanation
Correct answer: D. Critical items enter normally sterile tissue or the vascular system, and CDC recommends sterilizing them before use on each patient.
Why the other choices don't fit
- A: High-level disinfection is the minimum for semicritical items that touch mucous membranes or nonintact skin, not items that enter sterile tissue.
- B: This level is not enough for anything entering sterile tissue.
- C: Low-level disinfection is for noncritical items that touch only intact skin.
Takeaway: Enters sterile tissue: critical item, sterilize it.
Source: CDC, Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008 guideline), Recommendation 3.a.
Question 4 of 50
Communication and documentation · CNOR-030
At the end of a case, the circulating nurse brings the patient to the PACU. The PACU nurse is busy with another patient, so the circulating nurse leaves a printed summary at the bedside and returns to the OR. What was missing?
- A. The anesthesia professional's signature on the printed summary
- B. A verbal exchange that let the PACU nurse ask questions
- C. A copy of the operative note
- D. Nothing; a written summary is equivalent to a verbal report.
Show answer and explanation
Correct answer: B. Joint Commission requires a handoff process that provides the opportunity for discussion between the giver and receiver of patient information. A document left at the bedside does not.
Why the other choices don't fit
- A: A signature does not create a two-way exchange of information.
- C: More paper still is not a handoff.
- D: Written information can support a handoff, but it cannot answer the receiver's questions.
Takeaway: A handoff is a two-way exchange, not a document drop.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.01.04.01, EP 2 (p. 2).
Question 5 of 50
Emergency situations · CNOR-043
The anesthesia professional suspects malignant hyperthermia and asks the circulating nurse to reconstitute dantrolene supplied in 20 mg vials of the Dantrium or Revonto formulation. What should be used to reconstitute each vial?
- A. 60 mL of bacteriostatic water for injection, to limit contamination
- B. 20 mL of 0.9% sodium chloride per vial, shaken until clear
- C. 5 mL of sterile water for injection per vial, shaken until opaque
- D. 60 mL sterile water for injection, no bacteriostatic agent
Show answer and explanation
Correct answer: D. MHAUS directs that each 20 mg vial of Dantrium or Revonto be reconstituted with 60 mL of sterile water for injection, USP, without a bacteriostatic agent, then shaken until clear.
Why the other choices don't fit
- A: MHAUS specifies water without a bacteriostatic agent.
- B: Saline is not the listed diluent, and the volume is wrong.
- C: 5 mL is the MHAUS volume for a 250 mg vial of a different formulation (Ryanodex), not a 20 mg vial.
Takeaway: Know your dantrolene formulation; each 20 mg Dantrium or Revonto vial takes 60 mL of sterile water for injection without a bacteriostatic agent.
Source: MHAUS, Managing A Crisis: Emergency Treatment for an Acute MH Event, Emergency treatment steps: dantrolene.
Question 6 of 50
Personnel, services and materials · CNOR-025
The surgical services department wants to start buying bone allograft from a new tissue supplier. Before accepting the first shipment, what must the hospital confirm about the supplier?
- A. Its products are already used by a nearby hospital with a good safety record.
- B. It can provide a certificate of liability insurance.
- C. It is registered with the FDA as a tissue establishment.
- D. Its sales representative has completed vendor credentialing.
Show answer and explanation
Correct answer: C. For this bone allograft supplier, Joint Commission requires the hospital to confirm registration with the US Food and Drug Administration as a tissue establishment and a state license when required.
Why the other choices don't fit
- A: Another hospital's choice is not verification of this supplier.
- B: Insurance is a contracting issue, not the tissue-safety requirement.
- D: Rep credentialing governs people in the OR, not the source of the tissue.
Takeaway: Bone allografts come from FDA-registered tissue establishments, with state licensure where required.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.09.01.01, EP 2 (p. 26).
Question 7 of 50
Intraoperative patient care and safety · CNOR-014
The scrub person transfers bupivacaine into a medicine cup on the back table for later use. Which pair of items must appear on the label?
- A. Medication name and strength
- B. Patient's room number and surgeon's name
- C. Vial lot number and manufacturer
- D. Scrub person's initials and case start time
Show answer and explanation
Correct answer: A. Joint Commission requires the label to include the medication or solution name, strength, amount (if not apparent from the container), diluent name and volume (if not apparent), and expiration date and time (not required for short procedures as defined by the hospital).
Why the other choices don't fit
- B: Neither is a required label element, and neither identifies the medication or its strength.
- C: These trace the product but are not the required label elements for a container on the field.
- D: Useful for some local practices, but they do not tell the team what is in the cup.
Takeaway: Name and strength always; add amount, diluent, and expiration when the rule calls for them.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.14.03.01, EP 3 (p. 44).
Question 8 of 50
Plan of care and outcomes · CNOR-009
Before a total knee replacement, the nurse and patient are setting postoperative pain management goals. Which goal is realistic, measurable, and something the patient can understand?
- A. "I will have no pain at all after surgery, so I can rest comfortably and sleep through the night."
- B. "I'll walk to the bathroom with my walker the day after surgery, with tolerable pain."
- C. "My pain will be managed according to the hospital's postoperative pain protocol."
- D. "The nurse will give me pain medicine every four hours, whether or not I ask for it."
Show answer and explanation
Correct answer: B. Joint Commission asks for realistic expectations and measurable goals the patient understands, with progress judged by relief and function. This goal names a specific activity and a time frame, so everyone can tell whether it was met.
Why the other choices don't fit
- A: Promising no pain at all is not a realistic basis for this postoperative goal.
- C: This describes the process, not an outcome the patient can see or measure.
- D: That is a nursing intervention, not a patient outcome.
Takeaway: Good goals name a realistic, measurable outcome, often a function, that the patient understands.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.06.02.01, EP 5 (p. 21).
Question 9 of 50
Professional accountabilities · CNOR-048
The circulating nurse catches a mislabeled syringe on the back table before any medication reaches the patient. A colleague says there is no need to report it because no harm occurred. What should the nurse do?
- A. Skip reporting because the error never reached the patient.
- B. Report it only if the same thing happens again.
- C. Report it only if the patient or family asks about it.
- D. Report the close call through the internal reporting system.
Show answer and explanation
Correct answer: D. Joint Commission expects the hospitalwide safety program to cover the full range of safety issues, including close calls, and expects leaders to provide systems for internal reporting without retaliation.
Why the other choices don't fit
- A: Close calls are how organizations find system weaknesses before someone is harmed.
- B: Waiting for a repeat loses the chance to fix the system now.
- C: Reporting is about improving safety, not responding to questions.
Takeaway: Close calls get reported; they are free lessons.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.02.03.01, EPs 1 and 4 (p. 8).
Question 10 of 50
Assessment and diagnosis · CNOR-002
A patient is brought from preoperative holding to the operating room. Which pair of identifiers meets the Joint Commission requirement for confirming the patient's identity before care begins?
- A. The patient's full name and holding-area bay number
- B. The medical record number and the scheduled procedure
- C. The patient's full name and medical record number
- D. The wristband color and the patient's OR number
Show answer and explanation
Correct answer: C. Joint Commission requires at least two patient identifiers and gives an assigned identification number, such as a medical record number, as an example. Both items here are specific to the person.
Why the other choices don't fit
- A: Room number or physical location may not be used as an identifier. Patients move, and bays are reused all day.
- B: The procedure is what you are verifying, not who the patient is. It cannot serve as one of the two identifiers.
- D: A wristband color identifies a category, not a person, and the OR number is a location. Neither counts.
Takeaway: Two person-specific identifiers; never a room, bay, or other location.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.01.01.01, EP 1 (p. 1).
Question 11 of 50
Infection prevention · CNOR-036
A reusable anesthesia breathing circuit component contacts the patient's mucous membranes but does not enter sterile tissue. What processing does CDC recommend, at a minimum?
- A. Low-level disinfection
- B. Cleaning with detergent only
- C. High-level disinfection
- D. No processing if the item looks clean
Show answer and explanation
Correct answer: C. CDC recommends, at a minimum, high-level disinfection for semicritical equipment, such as endotracheal tubes and anesthesia breathing circuits, that touches mucous membranes or nonintact skin.
Why the other choices don't fit
- A: Low-level disinfection is for noncritical items that touch only intact skin.
- B: Cleaning is a necessary first step, not the endpoint for a semicritical item.
- D: Appearance says nothing about microbial contamination.
Takeaway: Touches mucous membranes: semicritical, high-level disinfection at minimum.
Source: CDC, Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008 guideline), Recommendation 3.b.
Question 12 of 50
Intraoperative patient care and safety · CNOR-015
The circulating nurse dispenses heparinized saline from its vial into a sterile container held by the scrub person. The scrub person prepares it on the field for the surgeon to use later. How should the medication and its label be verified?
- A. Both qualified team members verify it together, out loud and by looking at it.
- B. The circulating nurse reads the name aloud; the scrub person does not need to look.
- C. The scrub person checks it visually after the circulating nurse leaves the field.
- D. The team verifies it at the end of the case while documenting.
Show answer and explanation
Correct answer: A. Joint Commission requires verbal and visual verification of medication and solution labels, done by two individuals qualified to participate in the procedure whenever the person preparing the medication is not the person who will administer it.
Why the other choices don't fit
- B: Verbal verification alone misses look-alike errors. The requirement is verbal and visual.
- C: One person checking alone is not two-person verification.
- D: Verification after use cannot prevent an error. It happens when the medication is transferred and labeled.
Takeaway: When different people prepare and administer a medication, verify the label verbally and visually with two qualified people.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.14.03.01, EP 4 (p. 44).
Question 13 of 50
Intraoperative patient care and safety · CNOR-016
An orthopedic surgeon finishes a carpal tunnel release. During the same anesthetic, a plastic surgeon will now remove a lesion from the patient's opposite arm. What must happen before the second procedure begins?
- A. Nothing further; the first time-out covered the whole anesthetic.
- B. The plastic surgeon signs the consent, which replaces a time-out.
- C. A time-out is needed only if the patient is repositioned.
- D. A new time-out that includes the plastic surgeon
Show answer and explanation
Correct answer: D. Joint Commission requires a time-out before each procedure when two or more procedures are performed on the same patient and the person performing the procedure changes.
Why the other choices don't fit
- A: The first time-out verified a different procedure, site, and surgeon.
- B: A consent and a time-out do different jobs. One does not stand in for the other.
- C: Repositioning is not the trigger. A change in who performs the procedure is.
Takeaway: New proceduralist, new procedure: new time-out.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.01.06.03, EP 3 (p. 6).
Question 14 of 50
Communication and documentation · CNOR-031
During a case, the lab calls the OR with a critical potassium result, and the circulating nurse takes the call. What is the correct next step?
- A. Enter it in the chart so the PACU team can address it once the patient arrives after the case.
- B. Tell the scrub person, who is closest to the surgeon.
- C. Report it to the responsible practitioner per the facility's critical-results procedure.
- D. Ask the lab to call back after the case.
Show answer and explanation
Correct answer: C. Joint Commission requires written procedures that define critical results, who reports them to whom, and the acceptable time between availability and reporting. The nurse follows that procedure now, not later.
Why the other choices don't fit
- A: Charting it for later misses the defined reporting time frame.
- B: Telling only the scrub person does not establish that the responsible practitioner received the critical result within the required time frame.
- D: Delaying a critical result defeats the purpose of the process.
Takeaway: Critical results go to the right person within the defined time frame.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.01.02.01, EP 1 (p. 1).
Question 15 of 50
Emergency situations · CNOR-044
Shortly after a surgeon infiltrates a large volume of local anesthetic, the anesthesia professional identifies local anesthetic systemic toxicity (LAST), calls for help, and asks for the LAST rescue kit. Which therapy does the ASRA checklist call for considering early?
- A. Vasopressin
- B. A calcium channel blocker
- C. Additional local anesthetic to treat the arrhythmia
- D. 20% lipid emulsion
Show answer and explanation
Correct answer: D. ASRA's LAST checklist says to call for help, get the LAST rescue kit, and consider administering 20% lipid emulsion early.
Why the other choices don't fit
- A: ASRA lists vasopressin among drugs to avoid in LAST.
- B: ASRA lists calcium channel blockers among drugs to avoid in LAST.
- C: ASRA says to avoid local anesthetics during LAST resuscitation.
Takeaway: LAST: call for help, get the kit, and think lipid emulsion early.
Source: ASRA Pain Medicine, Checklist for Treatment of Local Anesthetic Systemic Toxicity, Checklist, lipid emulsion and "avoid" sections.
Question 16 of 50
Personnel, services and materials · CNOR-026
Frozen allograft tissue is kept in a dedicated freezer in the OR suite. Which practice meets Joint Commission requirements for this storage?
- A. Check the freezer temperature only when tissue is removed for a case.
- B. Follow the supplier's directions and keep daily temperature records.
- C. Move the tissue to a room-temperature shelf if the freezer alarms overnight.
- D. Keep the tissue in the freezer but silence its alarm overnight to avoid nuisance calls.
Show answer and explanation
Correct answer: B. Joint Commission requires following the supplier's written directions, daily records showing temperature-controlled tissue stayed at required temperatures, continuous temperature monitoring, and functional alarms with an emergency backup plan.
Why the other choices don't fit
- A: Checking only at removal leaves days of storage undocumented.
- C: Moving frozen tissue to room temperature defeats the storage requirement. The backup plan should keep it at the required temperature.
- D: Storage equipment for temperature-controlled tissue must have functional alarms and an emergency backup plan.
Takeaway: Supplier directions, daily temperature records, alarms, and a backup plan.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.09.01.01, EPs 3-6 (p. 26).
Question 17 of 50
Assessment and diagnosis · CNOR-003
During the preoperative assessment, the medication list from the patient's record shows lisinopril. The patient says a new doctor stopped lisinopril last month and started a different blood pressure pill, and adds that she takes a fish oil capsule every day. What is the nurse's best action?
- A. Copy the list exactly as it appears in the record, since it came from the pharmacy and is the most reliable source.
- B. Delete lisinopril from the list and leave the new medication off until the patient remembers its name.
- C. Tell the patient to bring her pill bottles to the postoperative visit.
- D. Record what she actually takes and flag the differences for reconciliation.
Show answer and explanation
Correct answer: D. Joint Commission expects a good-faith effort to capture the medications a patient is currently taking, then a comparison with the medications ordered so that discrepancies such as omissions, changes, and unclear information are identified and resolved. That is exactly what this patient's report requires.
Why the other choices don't fit
- A: A list that conflicts with what the patient is taking is the discrepancy you are supposed to catch, not a record to preserve.
- B: Removing one item without capturing the replacement leaves the list incomplete. Other sources, such as the prescriber or pharmacy, can fill the gap.
- C: The information matters now, before anesthesia and surgery, not after.
Takeaway: Capture what the patient really takes, then compare and resolve the differences.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.14.05.01, EPs 1 and 3 (pp. 44-45).
Question 18 of 50
Infection prevention · CNOR-037
After a long case, instruments are heavily soiled with blood, and the tray will not reach decontamination for over an hour. Why does CDC recommend cleaning as soon as practical after use?
- A. Dried soil is harder to remove and can make sterilization less effective.
- B. Point-of-use cleaning replaces the need for decontamination.
- C. Sterilization kills organisms regardless of soil, so the timing only matters for appearance.
- D. It is required only for instruments used on patients with known infections.
Show answer and explanation
Correct answer: A. CDC recommends cleaning devices as soon as practical after use because soiled material dries onto instruments, and dried or baked-on material undermines later disinfection or sterilization.
Why the other choices don't fit
- B: It is a first step. Meticulous cleaning in processing still follows.
- C: Residual soil can shield organisms and make sterilization less effective.
- D: CDC applies standard cleaning and sterilization to all patient-care devices.
Takeaway: Keep soil from drying; clean early so sterilization can work.
Source: CDC, Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008 guideline), Recommendations 2.b and 2.b.ii.
Question 19 of 50
Intraoperative patient care and safety · CNOR-017
A surgeon asks to "knock out the time-out" in preoperative holding so the case can start the moment the patient is draped. Which statement is correct?
- A. It happens right before incision, with the whole immediate team.
- B. Holding is fine as long as the patient participates.
- C. The time-out can be completed after the incision as long as it is documented in the record.
- D. Only the surgeon and circulating nurse need to participate.
Show answer and explanation
Correct answer: A. Joint Commission places the time-out immediately before starting the invasive procedure or making the incision. It involves the immediate team members, including the person performing the procedure, the anesthesia providers, the circulating nurse, and the OR technician, who agree at minimum on patient, site, and procedure.
Why the other choices don't fit
- B: Patient involvement matters in pre-procedure verification, but the time-out belongs in the room, right before incision.
- C: A time-out after incision cannot prevent a wrong-site or wrong-procedure event.
- D: Anesthesia providers, the OR technician, and other active participants are part of the team that must agree.
Takeaway: Right before incision, whole immediate team, agreement on patient, site, and procedure.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.01.06.03, EPs 1, 2, and 4 (p. 6).
Question 20 of 50
Plan of care and outcomes · CNOR-010
Before discharge from an ambulatory surgery center, the nurse reviews incision care with a patient. Which response best shows that the teaching was understood?
- A. She says, "Yes, I understand everything," and asks no further questions.
- B. She signs the discharge instruction sheet after reading it with the nurse.
- C. She explains, in her own words, when to change the dressing and what to report.
- D. Her spouse nods throughout the teaching and says they'll manage everything at home.
Show answer and explanation
Correct answer: C. Hearing the patient teach the information back in her own words shows what she understood. It also shows you what needs reteaching.
Why the other choices don't fit
- A: Saying yes does not demonstrate understanding. A patient can agree while still needing clarification.
- B: A signature documents that instructions were given, not that they were understood.
- D: Nodding by a family member does not show what either of them can actually explain or do.
Takeaway: Understanding is shown by the patient's own explanation, not by agreement or a signature.
Source: AHRQ TeamSTEPPS, Tool: Teach-Back, Tool description.
Question 21 of 50
Assessment and diagnosis · CNOR-004
The surgeon is running late in another room and asks the circulating staff RN, who is not an APRN or another permitted delegate, to mark the operative site on a patient scheduled for left shoulder arthroscopy so the case can start on time. Under Joint Commission requirements, who should mark the site?
- A. The circulating nurse, because the nurse has already verified the signed consent with the patient
- B. The accountable surgeon who will be present for the procedure
- C. The patient, using a marker the nurse provides
- D. The anesthesia professional, after placing the regional block
Show answer and explanation
Correct answer: B. The site is marked by the licensed practitioner ultimately accountable for the procedure who will be present. Delegation is allowed only in limited circumstances defined by the hospital, and only to a supervised physician in postgraduate training or to an APRN or PA working under a collaborative or supervisory agreement, who knows the patient and will be present.
Why the other choices don't fit
- A: The circulating RN in this scenario does not meet the requirements for a permitted delegate; verified consent does not change that.
- C: The patient should be involved in marking when possible, but the patient does not perform the marking.
- D: The anesthesia professional is not the practitioner accountable for the surgical procedure.
Takeaway: The accountable proceduralist marks the site; any delegate must meet the specific qualifications and hospital policy.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.01.06.02, EPs 2-3 (p. 5).
Question 22 of 50
Infection prevention · CNOR-038
A steam sterilization load contains an implantable orthopedic screw set for an elective case tomorrow. What does CDC recommend for this load?
- A. Release the implants once the external chemical indicator on each package has changed.
- B. Rely on the sterilizer's weekly biological indicator.
- C. Plan to flash sterilize the implants tomorrow instead.
- D. Run a biological indicator and quarantine the implants until it's negative.
Show answer and explanation
Correct answer: D. CDC recommends biological indicators for every load containing implantable items and quarantining those items, whenever possible, until the biological indicator is negative.
Why the other choices don't fit
- A: External indicators show exposure to the process, not that spores were killed.
- B: Weekly testing monitors the sterilizer. Loads with implants need their own biological indicator.
- C: CDC says not to flash sterilize implanted devices unless it is unavoidable, and an elective case scheduled a day ahead is avoidable.
Takeaway: Implant loads: a biological indicator every time, and quarantine until it's negative whenever possible.
Source: CDC, Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008 guideline), Recommendations 16.d, 16.g, and 13.a.
Question 23 of 50
Intraoperative patient care and safety · CNOR-018
During the closing count for an elective open colectomy, the sponge count is one short. The patient is stable. What should the circulating nurse do first?
- A. Recount with the scrub person only, then allow closure if you both believe the first count was wrong.
- B. Tell the surgeon and team immediately and start the discrepancy procedure.
- C. Let closure continue and arrange a radiograph in the PACU.
- D. File an incident report after the patient leaves the room.
Show answer and explanation
Correct answer: B. ACS recommends standardized counts, methodical wound exploration before closure, and X-ray or other technology as indicated to make sure nothing is left behind. Everyone on the team shares responsibility, so the surgeon needs to know immediately.
Why the other choices don't fit
- A: A private recount that skips the surgeon and the search can miss a real retained sponge.
- C: For this stable patient, resolving the discrepancy is part of the end of surgery, before the patient leaves the room. Finding the sponge after closure may mean a second operation.
- D: Reporting has a place, but it does nothing to find the sponge now.
Takeaway: In this stable elective case, a count discrepancy is a team event to resolve before the patient leaves the OR.
Source: American College of Surgeons, Revised Statement on the Prevention of Unintentionally Retained Surgical Items After Surgery, Recommendation list and NQF end-of-surgery definition.
Question 24 of 50
Communication and documentation · CNOR-032
A patient receives a bone allograft. Which documentation best supports the requirement that tissue be traceable from donor or supplier to recipient and back?
- A. A note in the operative report stating that a bone allograft was implanted during the case
- B. Keeping the outer shipping box for 30 days
- C. Recording the vendor representative's name
- D. The tissue's identification number and supplier, in the patient record and tissue log
Show answer and explanation
Correct answer: D. Joint Commission requires records that allow any tissue to be traced from the donor or supplier to the recipient and from the recipient back to the donor or supplier. That only works if the specific tissue is identified in both places.
Why the other choices don't fit
- A: A general note cannot link this patient to a specific donor or lot.
- B: Packaging is not a record, and it will be discarded.
- C: The rep's name does not identify the tissue.
Takeaway: Traceability depends on recording the specific tissue's identifiers.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.09.02.01, EP 1 (p. 27).
Question 25 of 50
Emergency situations · CNOR-045
A patient positioned prone on a spinal frame, with an open posterior incision, becomes pulseless. The team agrees the patient cannot be turned supine safely and quickly. What is the most appropriate action?
- A. Begin CPR with the patient in the prone position.
- B. Hold compressions until the patient can be turned supine.
- C. Give rescue breaths only until the patient can be turned.
- D. Wait for defibrillator pads before starting compressions.
Show answer and explanation
Correct answer: A. AHA's 2025 guidelines note it may be reasonable to turn a patient supine before compressions, but if the patient cannot be safely turned, rescuers may consider performing CPR in the prone position. Delays in starting compressions are associated with worse outcomes.
Why the other choices don't fit
- B: Waiting delays chest compressions, one of the most important interventions for survival.
- C: Rescue breathing alone is for patients who have a pulse.
- D: AHA recommends CPR until a defibrillator is applied, not waiting for it.
Takeaway: When a prone patient cannot be safely turned supine, prone CPR is an option rather than waiting without compressions.
Source: American Heart Association, Part 7: Adult Basic Life Support (2025 Guidelines for CPR and ECC), Section 7.1, recommendation 6; Section 9.2, recommendation 1.
Question 26 of 50
Personnel, services and materials · CNOR-027
The only RN circulating in an OR is asked to leave for 45 minutes to cover a room in another building, leaving a surgical technologist to circulate alone for the rest of the case. Which statement is correct?
- A. It is acceptable if the surgical technologist holds a current national certification.
- B. It is acceptable if the surgeon agrees to supervise the technologist for the rest of the case.
- C. It isn't acceptable; a qualified RN must remain immediately available.
- D. It is acceptable as long as the RN can be reached by phone.
Show answer and explanation
Correct answer: C. Joint Commission requires qualified registered nurses to perform circulating duties. LPNs and surgical technologists may assist, in line with state law and policy, only under the supervision of a qualified RN who is immediately available to respond to emergencies.
Why the other choices don't fit
- A: Certification does not change who may perform circulating duties or the supervision requirement.
- B: The requirement calls for a qualified RN, not the surgeon, to supervise.
- D: An RN in another building is not immediately available to respond to an emergency.
Takeaway: Circulating is an RN role; others assist only with an RN immediately available.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.12.01.01, EP 13 (p. 33).
Question 27 of 50
Professional accountabilities · CNOR-049
For the third time this month, a surgeon throws an instrument and shouts insults at a surgical technologist during a case. After immediate safety needs have been addressed, what is the nurse's most appropriate follow-up action?
- A. Ignore it, because the surgeon is highly skilled and patient outcomes are good.
- B. Report it through the facility's code-of-conduct process.
- C. Confront the surgeon loudly during the procedure.
- D. Advise the technologist to ask for other assignments.
Show answer and explanation
Correct answer: B. Joint Commission requires leaders to have a code of conduct that defines behaviors that undermine a culture of safety and a process for managing them. Using that process is the professional response.
Why the other choices don't fit
- A: Skill does not exempt anyone from the code of conduct, and the behavior puts the team and patient at risk.
- C: Escalating a conflict mid-case adds to the danger in the room.
- D: Moving the target does not address the behavior.
Takeaway: After immediate safety needs are addressed, disruptive behavior goes through the facility's code-of-conduct process.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.02.03.01, EPs 12-13; NPG.02.04.01, EPs 1-2 (p. 9).
Question 28 of 50
Intraoperative patient care and safety · CNOR-019
In preoperative holding, the nurse notices the surgeon marked the operative site only with a small removable adhesive arrow. What should the nurse do?
- A. Accept the arrow, since it is on the correct side and the patient confirmed the site with you.
- B. Draw an ink mark next to the arrow yourself.
- C. Remove the arrow and rely on the consent form during the time-out.
- D. Ask the surgeon to re-mark the site so it stays visible after prep and draping.
Show answer and explanation
Correct answer: D. Joint Commission requires a mark made at or near the site that is permanent enough to be visible after prep and draping, and states that adhesive markers cannot be the only means of marking.
Why the other choices don't fit
- A: Being on the correct side does not help if the mark is removed or covered.
- B: The circulating role alone does not establish the qualifications and authorization needed to mark the site.
- C: That removes the only mark and leaves the site unmarked.
Takeaway: The mark must survive prep and draping; adhesives cannot be the only mark.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.01.06.02, EPs 3-4 (pp. 5-6).
Question 29 of 50
Assessment and diagnosis · CNOR-005
A 79-year-old with a documented do-not-resuscitate (DNR) order is scheduled for a palliative gastrostomy under general anesthesia. The chart has no note about how the DNR applies during the procedure. What is the most appropriate nursing action?
- A. Treat the DNR as automatically suspended, because consenting to general anesthesia implies consent to resuscitation.
- B. Ask the surgeon and anesthesia professional to review the DNR with the patient.
- C. Cancel the procedure because a patient with a DNR order cannot receive general anesthesia.
- D. Ask the patient privately which measures they would accept and change the order yourself.
Show answer and explanation
Correct answer: B. ASA's ethical guidance calls for reviewing existing DNR orders with the patient or designated surrogate before anesthetic care, clarifying or modifying them based on the patient's preferences, and documenting the result. The nurse's job is to make sure that conversation happens before the patient is anesthetized.
Why the other choices don't fit
- A: ASA states that policies automatically suspending DNR orders may not adequately respect a patient's right to self-determination.
- C: A DNR order does not by itself rule out anesthesia. ASA describes several options, from full suspension to limited resuscitation, chosen with the patient.
- D: Clarifying the order is a documented discussion led by the physicians involved. A nurse cannot modify the order independently.
Takeaway: DNR orders get a documented reconsideration before anesthesia, not automatic suspension.
Source: American Society of Anesthesiologists, Statement on Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate Orders, Items 1-4 and 6-7.
Question 30 of 50
Infection prevention · CNOR-039
Opening a peel pack, the circulating nurse notices a water stain and a small puncture. The pack's sterilization record shows acceptable results. What should the nurse do?
- A. Do not use it; send it back to be repackaged and reprocessed.
- B. Use it, because the sterilization record proves it was sterile.
- C. Use it if the internal chemical indicator changed color.
- D. Wipe the package with alcohol and use it.
Show answer and explanation
Correct answer: A. CDC recommends evaluating packages before use and repacking and reprocessing any pack whose integrity is compromised, such as torn, wet, or punctured.
Why the other choices don't fit
- B: Acceptable processing records do not establish that a wet, punctured package has maintained its sterile barrier.
- C: The indicator reflects processing, not what happened to the package afterward.
- D: Wiping the outside cannot restore a breached barrier.
Takeaway: Treat compromised packages as nonsterile, whatever the load record says.
Source: CDC, Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008 guideline), Recommendations 18.e and 18.f.
Question 31 of 50
Intraoperative patient care and safety · CNOR-020
Before a laparoscopic procedure, the nurse sees that an alcohol-based skin prep has pooled at the umbilicus and soaked the linen under the patient's flank. The surgeon wants to drape now. What should the nurse do?
- A. Drape now; the drapes will contain the vapors away from the surgical field.
- B. Drape now and keep the electrosurgical unit on its lowest setting.
- C. Address the pooled prep according to its instructions, remove soaked linen, and let the prep dry fully before draping.
- D. Cover the wet area with a dry towel and proceed.
Show answer and explanation
Correct answer: C. APSF teaches that alcohol-based preps are highly flammable, should not be allowed to pool, and should be dry before drapes go on and ignition sources are used. Pooled prep and soaked linen are fuel sitting under the drapes.
Why the other choices don't fit
- A: Drapes trap vapors and can concentrate them near the ignition source, which increases fire risk.
- B: A lower setting is still an ignition source, and it does nothing about the fuel under the drapes.
- D: A towel over a flammable liquid adds more fuel instead of removing any.
Takeaway: No pooling, no soaked linen, and a fully dry prep before drapes and cautery.
Source: Anesthesia Patient Safety Foundation, OR Fire Prevention flyer ("Don't Fuel the Fire"), Fuel section; see also APSF OR Fire Prevention Algorithm. Also: Anesthesia Patient Safety Foundation, OR Fire Prevention Algorithm, Skin prep / fuel precautions.
Question 32 of 50
Plan of care and outcomes · CNOR-011
After a thoracotomy, a patient's pain management goal is to take deep breaths and use the incentive spirometer every hour. Thirty minutes after an analgesic, which reassessment finding best shows progress toward that goal?
- A. The patient rates her pain 3 out of 10 but refuses the spirometer because breathing deeply hurts.
- B. She uses the incentive spirometer 10 times and breathes deeply with manageable pain.
- C. The patient is sleeping quietly.
- D. Her blood pressure is lower than before the dose.
Show answer and explanation
Correct answer: B. Joint Commission lists progress toward goals, including functional ability such as taking a deep breath, as part of pain reassessment. This finding measures the very function the goal names.
Why the other choices don't fit
- A: A lower number is encouraging, but the patient still cannot do the activity the goal is built around.
- C: Sleep does not tell you whether she can breathe deeply and use the spirometer.
- D: A vital sign change is not a measure of the functional goal and can have many causes.
Takeaway: When the goal is functional, reassess the function.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.06.02.01, EP 7 (p. 21).
Question 33 of 50
Assessment and diagnosis · CNOR-006
A patient with limited English proficiency arrives for an elective hernia repair with her 15-year-old son, who has no interpreter training and offers to interpret the preoperative interview. What should the nurse do?
- A. Accept the son's help so the first case is not delayed.
- B. Use the facility's qualified interpreting services.
- C. Speak slowly in English and ask the patient to nod when she understands.
- D. Complete the interview from the chart and skip questions the patient cannot answer.
Show answer and explanation
Correct answer: B. Joint Commission requires hospitals to respect the patient's right to effective communication and to provide interpreting and translation services as necessary. A qualified interpreter is the standard for a preoperative assessment.
Why the other choices don't fit
- A: The son has no interpreter training, and he may filter or misunderstand sensitive health information.
- C: Nodding does not show understanding, and slowing down does not overcome a language barrier.
- D: Skipping the patient's own answers leaves gaps in the assessment that the chart cannot fill.
Takeaway: Use qualified interpreting services for this preoperative interview.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.07.01.01, EPs 1-2 (p. 22).
Question 34 of 50
Infection prevention · CNOR-040
Because the facility owns only one of a popular instrument set and those cases are booked back to back, a surgeon wants the team to use flash sterilization for it routinely. What does CDC recommend?
- A. It is acceptable if the instruments are cleaned first.
- B. It is acceptable if a biological indicator is run with each cycle.
- C. Don't use flash sterilization as a routine workaround.
- D. It is acceptable for implants when the schedule is tight.
Show answer and explanation
Correct answer: C. CDC states that flash sterilization should not be used for convenience, as an alternative to purchasing additional instrument sets, or to save time. It is for items that will be used immediately when necessary, such as an inadvertently dropped instrument.
Why the other choices don't fit
- A: Cleaning is required for any flash cycle, but it does not make routine convenience use acceptable.
- B: Monitoring is required, but the problem here is using flash as a scheduling workaround.
- D: CDC says not to flash sterilize implanted devices unless it is unavoidable. A tight schedule does not qualify.
Takeaway: Flash sterilization is for true immediate need, not for inventory or scheduling gaps.
Source: CDC, Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008 guideline), Recommendations 13.a, 13.b, and 13.e.
Question 35 of 50
Communication and documentation · CNOR-033
At the end of a trauma laparotomy, the surgeon intentionally leaves three laparotomy sponges in the abdomen as packing, planning to return to the OR in 24 hours. What should the circulating nurse document?
- A. A correct final count, because the packing was placed intentionally by the surgeon
- B. The counts, the sponges intentionally left as packing, and team notification
- C. An unintentionally retained surgical item
- D. Nothing until the sponges are removed at the next surgery
Show answer and explanation
Correct answer: B. ACS recommends documentation that includes the results of surgical item counts, notification of the surgical team, instruments or items intentionally left as packing, and actions taken if count discrepancies occur.
Why the other choices don't fit
- A: A 'correct count' entry alone would omit the intentional packing and team notification.
- C: The packing was deliberate and planned. Calling it unintentional misrepresents the event.
- D: The next team needs to know now what was left and why.
Takeaway: Intentional packing is documented explicitly, along with counts and team notification.
Source: American College of Surgeons, Revised Statement on the Prevention of Unintentionally Retained Surgical Items After Surgery, Documentation recommendation.
Question 36 of 50
Emergency situations · CNOR-046
In the PACU, an adult who received opioids is not breathing normally but has a strong, easily palpable pulse. At what rate should the nurse provide bag-mask ventilation?
- A. 1 breath every 2 seconds (about 30 breaths per minute)
- B. 2 breaths after every 30 compressions
- C. 1 breath every 6 seconds (10 breaths per minute)
- D. 1 breath every 15 seconds (4 breaths per minute)
Show answer and explanation
Correct answer: C. AHA's 2025 adult guidelines state it is reasonable to give 1 ventilation every 6 seconds, or 10 breaths per minute, each producing visible chest rise, for an adult in respiratory arrest with a pulse.
Why the other choices don't fit
- A: That rate risks hyperventilation, which AHA warns against.
- B: The 30:2 cycle is for cardiac arrest. This patient has a pulse.
- D: That rate would leave the patient underventilated.
Takeaway: Pulse present, not breathing normally: 1 breath every 6 seconds.
Source: American Heart Association, Part 7: Adult Basic Life Support (2025 Guidelines for CPR and ECC), Section 8.3, recommendation 2.
Question 37 of 50
Personnel, services and materials · CNOR-028
The circulating nurse is behind schedule and is considering which tasks to delegate to unlicensed assistive personnel who have been trained per facility policy. Which task should the nurse keep rather than delegate?
- A. Assessing the patient's readiness for surgery
- B. Bringing sterile supplies from central supply for the next case
- C. Restocking the room with standard supplies
- D. Bringing a warmed blanket to the patient
Show answer and explanation
Correct answer: A. Under the NCSBN and ANA delegation guidelines, a licensed nurse cannot delegate any activity that requires clinical reasoning, nursing judgment, or critical decision-making. Assessment and deciding what to report are exactly that.
Why the other choices don't fit
- B: Retrieving supplies does not require nursing judgment and can be delegated to trained staff.
- C: Restocking is a routine task that trained staff can do within policy.
- D: A simple comfort task does not require nursing judgment.
Takeaway: Nursing judgment, assessment, and clinical decisions stay with the licensed nurse.
Source: NCSBN and ANA, National Guidelines for Nursing Delegation, Licensed nurse responsibilities and the Five Rights of Delegation.
Question 38 of 50
Intraoperative patient care and safety · CNOR-021
Between cases, a colleague plans to use a partly filled syringe of medication left from the previous patient on the next patient, after attaching a new needle. What is the correct response?
- A. It is acceptable because the new needle is sterile.
- B. It is acceptable if the dose is given through IV tubing rather than directly.
- C. It is acceptable if the syringe was used within the past hour.
- D. Don't use it; draw up the dose with a new syringe and needle.
Show answer and explanation
Correct answer: D. CDC is explicit: do not give medication from the same syringe to more than one patient, even if the needle is changed or you inject through an intervening length of IV tubing. Once used, the syringe and needle are both contaminated.
Why the other choices don't fit
- A: The syringe itself is contaminated. A new needle does not change that.
- B: CDC specifically says intervening IV tubing does not make syringe reuse safe.
- C: Time is not the issue. Contamination is.
Takeaway: New patient, new needle, and new syringe, every time.
Source: CDC, Preventing Unsafe Injection Practices, Safe injection practices list.
Question 39 of 50
Intraoperative patient care and safety · CNOR-022
Three lymph node specimens are collected during a case. A colleague suggests leaving the containers unlabeled on the back table and labeling them all in the workroom after the patient leaves. What should the nurse do?
- A. Label them in the workroom after the case, using the OR schedule to match each one.
- B. Put all three nodes in one container labeled with the patient's name.
- C. Let the pathology department label them from the requisition.
- D. Label each specimen container in the OR while the patient is present.
Show answer and explanation
Correct answer: D. Joint Commission requires containers for blood and other specimens to be labeled in the presence of the patient. That keeps each label tied to the right patient.
Why the other choices don't fit
- A: Labeling away from the patient is exactly the practice the requirement is meant to prevent.
- B: Combining separately collected specimens can destroy information the pathologist needs about each one.
- C: Unlabeled containers arriving in pathology cannot be reliably matched to the right patient.
Takeaway: Label specimen containers in the patient's presence.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.01.01.01, EP 2 (p. 1).
Question 40 of 50
Assessment and diagnosis · CNOR-007
In the PACU, an adult with advanced dementia is grimacing and guarding her abdomen after surgery, but she cannot use the 0-10 number scale. How should the nurse assess her pain?
- A. Use a method suited to her condition, such as observing her behaviors.
- B. Record "unable to rate" and reassess once she is awake enough to use the number scale.
- C. Assume her pain is controlled because she is not asking for medication.
- D. Use the 0-10 scale anyway and record the first number she says.
Show answer and explanation
Correct answer: A. Joint Commission requires criteria to screen, assess, and reassess pain that fit the patient's age, condition, and ability to understand, and communication that meets the needs of patients with cognitive impairment. Grimacing and guarding are exactly the behaviors an observation-based approach captures.
Why the other choices don't fit
- B: She may never be able to use the number scale. Waiting leaves these signs of possible pain unassessed.
- C: Patients with cognitive impairment often cannot request relief. Not asking is not the same as not hurting.
- D: A number from a patient who cannot use the scale is not a valid assessment.
Takeaway: Match the pain assessment method to the patient's condition and ability to communicate.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.06.02.01, EP 1 (p. 20); NPG.07.01.01, EP 3 (p. 22).
Question 41 of 50
Infection prevention · CNOR-041
About 50 mL of blood spills onto the OR floor. The facility uses freshly diluted sodium hypochlorite (5.25-6.15% household bleach) for spills. After putting on gloves and other appropriate PPE, what does CDC recommend?
- A. Apply a 1:10 dilution before cleaning, then disinfect with 1:100.
- B. Use a 1:100 dilution only, because the OR floor is a nonporous surface.
- C. Pour undiluted bleach directly on the spill.
- D. Wipe it up with dry towels and disinfect at end-of-day terminal cleaning.
Show answer and explanation
Correct answer: A. For spills larger than about 10 mL of blood or other potentially infectious material, CDC recommends a 1:10 dilution for the first application before cleaning, to reduce infection risk if a sharps injury occurs during cleanup, followed by terminal disinfection with a 1:100 dilution.
Why the other choices don't fit
- B: A 1:100 dilution alone is CDC's approach for small spills of under about 10 mL.
- C: Undiluted bleach is not CDC's recommendation here.
- D: CDC calls for prompt cleaning and decontamination of blood spills.
Takeaway: For the specified bleach stock and large spill: 1:10 first, then 1:100 terminal disinfection.
Source: CDC, Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008 guideline), Recommendations 5.m, 5.n, and 5.n.1.
Question 42 of 50
Professional accountabilities · CNOR-050
A surgeon asks the circulating nurse, who has not been trained or authorized to first assist and whose facility does not permit this RN to close, to scrub in and close the fascia so the surgeon can leave for another case. What should the nurse do?
- A. Close the fascia, since the surgeon who asked will be responsible for the outcome.
- B. Close the fascia if the patient gave consent for the surgery.
- C. Decline, explain it's outside the nurse's authorized role, and notify the charge nurse.
- D. Close the fascia if you have watched it done many times.
Show answer and explanation
Correct answer: C. Joint Commission requires staff to practice within their lawful scope and to be oriented to their specific job duties. This nurse lacks the training and facility authorization for the requested task. The surgeon's request does not supply either.
Why the other choices don't fit
- A: The surgeon's request does not expand the nurse's authorized role.
- B: The patient's consent to surgery does not authorize an unqualified person to perform part of it.
- D: Watching is not training, validated competence, or authorization.
Takeaway: A request does not expand your authorized role; decline tasks you aren't authorized to perform and escalate.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.12.04.01, EP 3; NPG.12.05.01, EP 1 (p. 36).
Question 43 of 50
Intraoperative patient care and safety · CNOR-023
A patient is positioned for total hip arthroplasty. During pre-procedure verification, the circulating nurse learns the planned implant size is not in the building; the vendor says it will arrive in 40 minutes. The surgeon wants to make the incision now. What is the nurse's best action?
- A. Tell the surgeon and escalate per policy before the incision.
- B. Allow the incision, since the implant should arrive well before the team actually needs it.
- C. Open the nearest available size without telling the surgeon.
- D. Document the delay and proceed.
Show answer and explanation
Correct answer: A. Joint Commission's pre-procedure verification uses a standardized list to confirm that required implants, devices, and special equipment are available before the procedure. A missing implant means verification is not complete.
Why the other choices don't fit
- B: "Should arrive" is not verified. Delays happen, and the patient would already be open.
- C: Substituting an implant without the surgeon's knowledge is a serious safety and ethical failure.
- D: Documentation does not replace verification.
Takeaway: Required implants are confirmed available before the procedure begins.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.01.06.01, EP 2 (p. 5).
Question 44 of 50
Plan of care and outcomes · CNOR-012
A patient scheduled for an elective procedure later this morning asks to speak with a chaplain and receive a prayer before surgery. Which response best reflects patient-centered planning?
- A. Explain that visitors are not allowed in preoperative holding before the first case of the day.
- B. Arrange a chaplain visit and add the request to the plan of care.
- C. Tell the patient that spiritual needs can be addressed after recovery.
- D. Suggest rescheduling the surgery for a day when the chaplain has more time.
Show answer and explanation
Correct answer: B. Joint Commission requires hospitals to respect patients' cultural and personal values and preferences and to accommodate their right to religious and other spiritual services. Building the request into the plan is how that happens on a busy morning.
Why the other choices don't fit
- A: Refusing outright ignores a right the hospital is expected to accommodate.
- C: The patient asked for support before surgery, when it matters to her.
- D: Delaying care is a poor substitute for simply arranging the visit.
Takeaway: Spiritual and cultural requests belong in the plan of care.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.07.04.01, EPs 1-2 (p. 23).
Question 45 of 50
Communication and documentation · CNOR-034
At discharge from a hospital outpatient surgery department, a patient has one new prescription and has been told to stop one home medication for three days. Which action meets the Joint Commission requirement?
- A. Explain the changes verbally and ask the patient to repeat them back before leaving.
- B. Give the patient the new prescription only.
- C. Give a written list of the medications to take, including both changes.
- D. Tell the patient to ask their primary care provider which medications to take.
Show answer and explanation
Correct answer: C. Joint Commission requires hospitals to give the patient written information on the medications they should be taking at the end of an outpatient encounter, and to explain why managing this information matters.
Why the other choices don't fit
- A: Verbal instructions alone are easily forgotten after anesthesia, and they don't meet the requirement for written medication information.
- B: The new prescription alone omits the instructions for the paused home medication.
- D: The surgical team made the changes and needs to communicate them.
Takeaway: Outpatients leave with a written list of what to take.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.14.05.01, EPs 4-5 (p. 45).
Question 46 of 50
Emergency situations · CNOR-047
A patient under moderate sedation with supplemental oxygen by nasal cannula is having a forehead lesion excised with electrosurgery. Which action most directly addresses the oxidizer side of the fire triangle?
- A. Work with anesthesia to keep oxygen below 30% or use room air, if tolerated.
- B. Let the alcohol-based skin prep dry completely before the drapes are placed on the face
- C. Holster the electrosurgical pencil when it is not in use.
- D. Moisten sponges used near the surgical site.
Show answer and explanation
Correct answer: A. APSF's fire prevention algorithm uses room air when supplemental oxygen is not needed. When oxygen is needed, a controlled delivery device such as a blender can keep its concentration below 30% if oxygenation permits; when more than 30% is required, the algorithm directs securing the airway. That targets the oxidizer directly.
Why the other choices don't fit
- B: Important, but it addresses fuel, not the oxidizer.
- C: Also important, but it addresses the ignition source.
- D: Wet sponges reduce available fuel, not the oxidizer.
Takeaway: Fire triangle: oxidizer (oxygen), fuel (preps, drapes, sponges), ignition (cautery). Know which lever you're pulling.
Source: Anesthesia Patient Safety Foundation, OR Fire Prevention Algorithm, Supplemental oxygen branch. Also: Anesthesia Patient Safety Foundation, OR Fire Prevention flyer ("Don't Fuel the Fire"), Fuel, oxidizer, and ignition-source precautions (p. 1).
Question 47 of 50
Personnel, services and materials · CNOR-029
While assembling a tray, the scrub person finds a reusable grasper whose jaws no longer close fully. The instrument looks clean. What should happen?
- A. Use it for this case, since it can still grasp and hold tissue.
- B. Remove it from service for repair or replacement.
- C. Resterilize it and return it to the tray.
- D. Tape the jaws together and label it "use with caution."
Show answer and explanation
Correct answer: B. CDC recommends inspecting equipment and discarding or repairing any device that no longer functions as intended or cannot be properly cleaned and disinfected or sterilized.
Why the other choices don't fit
- A: A grasper that does not close properly can slip, tear tissue, or drop items.
- C: Sterilization does nothing to fix a mechanical failure.
- D: Taping the jaws together does not repair the grasper or restore its intended function.
Takeaway: Instruments that don't work as intended come out of service.
Source: CDC, Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008 guideline), Recommendation 2.f.
Question 48 of 50
Assessment and diagnosis · CNOR-008
In preoperative holding, an alert adult with decision-making capacity who signed consent yesterday for an elective laparoscopic cholecystectomy says, "I've changed my mind. I don't want the surgery." No sedation has been given. What should the nurse do?
- A. Remind the patient that the consent is already signed and continue preparations.
- B. Give the ordered preoperative sedative to ease her anxiety, then ask again.
- C. Document the statement and proceed if the surgeon agrees.
- D. Stop preparations and notify the surgeon of her decision.
Show answer and explanation
Correct answer: D. Joint Commission requires hospitals to honor the patient's right to give or withhold informed consent. A capable adult can withdraw consent before an elective procedure, and the team needs to know right away.
Why the other choices don't fit
- A: A signature does not remove the patient's right to change their mind before the procedure.
- B: Sedating a patient who has just refused the procedure undermines her ability to make the decision.
- C: The surgeon cannot override a capable patient's refusal of an elective procedure.
Takeaway: A capable adult can withdraw consent at any point before an elective procedure.
Source: Joint Commission, National Performance Goals, Hospital Program (effective January 2026), NPG.07.02.01 (p. 22).
Question 49 of 50
Infection prevention · CNOR-042
The internal chemical indicator in an instrument tray has not changed to show the tray was processed, although the external indicator tape did change. What should happen?
- A. Don't use the tray; return it for reprocessing.
- B. Use it, because the external tape confirms it went through the sterilizer.
- C. Use it if last week's biological indicator was negative.
- D. Use it if the surgeon approves.
Show answer and explanation
Correct answer: A. CDC recommends not using processed items if mechanical or chemical indicators, internal or external, suggest inadequate processing.
Why the other choices don't fit
- B: External tape shows exposure on the outside. The internal indicator is telling you conditions inside the tray may not have been met.
- C: A past biological indicator result says nothing about this tray.
- D: Approval does not make an inadequately processed tray sterile.
Takeaway: Any indicator that suggests inadequate processing takes the item out of use.
Source: CDC, Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008 guideline), Recommendation 16.c.
Question 50 of 50
Intraoperative patient care and safety · CNOR-024
The circulating nurse is recording the wound class for an elective laparoscopic cholecystectomy. The gallbladder was removed without spillage, no inflammation or infection was found, and there was no break in sterile technique. Using the traditional four-class wound scheme, which wound class fits?
- A. Class I, clean
- B. Class II, clean-contaminated
- C. Class III, contaminated
- D. Class IV, dirty-infected
Show answer and explanation
Correct answer: B. Clean-contaminated wounds involve controlled entry into the respiratory, alimentary, genital, or urinary tract without unusual contamination. The traditional classification specifically includes biliary surgery when there is no infection or major break in technique. CDC's NHSN also notes that gallbladder surgery (CHOL) cannot be recorded as clean.
Why the other choices don't fit
- A: Clean wounds do not enter the alimentary tract, and NHSN will not accept a clean class for gallbladder surgery.
- C: Contaminated wounds involve a major break in sterile technique, gross spillage from the GI tract, or acute nonpurulent inflammation. None occurred here.
- D: Dirty-infected wounds involve existing infection, gross purulence, or perforated organs. None were found.
Takeaway: Under this scheme, controlled biliary entry without infection, unusual contamination, or a major break in technique is clean-contaminated.
Source: CDC/HICPAC, Guideline for Prevention of Surgical Site Infection, 1999 — Table 7: Surgical Wound Classification, Table 7, printed p. 259 (PDF p. 13); traditional classification definitions only, not current SSI prevention guidance. Also: CDC NHSN Patient Safety Component Manual, Chapter 9: Surgical Site Infection Event, Wound class, p. 9-10 (PDF p. 10): local assignment and CHOL exclusion from clean classification.
Score your practice set
Check your answers against the key below, then count how many you got right in each subject area. For first-attempt feedback, count only answers you chose before seeing an explanation or the key: correct ÷ answered × 100. Leave previewed and unanswered items out of the denominator; with no answers, there is no percentage. Your percentage describes your answers to these 50 items. It is not CCI's scaled score and it doesn't predict whether you'll pass. Some subject areas have only three to five questions here, so one answer can swing an area's result a lot.
Show the answer key
| Question | Answer | Subject area | ID |
|---|---|---|---|
| 1 | A | Assessment and diagnosis | CNOR-001 |
| 2 | C | Intraoperative patient care and safety | CNOR-013 |
| 3 | D | Infection prevention | CNOR-035 |
| 4 | B | Communication and documentation | CNOR-030 |
| 5 | D | Emergency situations | CNOR-043 |
| 6 | C | Personnel, services and materials | CNOR-025 |
| 7 | A | Intraoperative patient care and safety | CNOR-014 |
| 8 | B | Plan of care and outcomes | CNOR-009 |
| 9 | D | Professional accountabilities | CNOR-048 |
| 10 | C | Assessment and diagnosis | CNOR-002 |
| 11 | C | Infection prevention | CNOR-036 |
| 12 | A | Intraoperative patient care and safety | CNOR-015 |
| 13 | D | Intraoperative patient care and safety | CNOR-016 |
| 14 | C | Communication and documentation | CNOR-031 |
| 15 | D | Emergency situations | CNOR-044 |
| 16 | B | Personnel, services and materials | CNOR-026 |
| 17 | D | Assessment and diagnosis | CNOR-003 |
| 18 | A | Infection prevention | CNOR-037 |
| 19 | A | Intraoperative patient care and safety | CNOR-017 |
| 20 | C | Plan of care and outcomes | CNOR-010 |
| 21 | B | Assessment and diagnosis | CNOR-004 |
| 22 | D | Infection prevention | CNOR-038 |
| 23 | B | Intraoperative patient care and safety | CNOR-018 |
| 24 | D | Communication and documentation | CNOR-032 |
| 25 | A | Emergency situations | CNOR-045 |
| 26 | C | Personnel, services and materials | CNOR-027 |
| 27 | B | Professional accountabilities | CNOR-049 |
| 28 | D | Intraoperative patient care and safety | CNOR-019 |
| 29 | B | Assessment and diagnosis | CNOR-005 |
| 30 | A | Infection prevention | CNOR-039 |
| 31 | C | Intraoperative patient care and safety | CNOR-020 |
| 32 | B | Plan of care and outcomes | CNOR-011 |
| 33 | B | Assessment and diagnosis | CNOR-006 |
| 34 | C | Infection prevention | CNOR-040 |
| 35 | B | Communication and documentation | CNOR-033 |
| 36 | C | Emergency situations | CNOR-046 |
| 37 | A | Personnel, services and materials | CNOR-028 |
| 38 | D | Intraoperative patient care and safety | CNOR-021 |
| 39 | D | Intraoperative patient care and safety | CNOR-022 |
| 40 | A | Assessment and diagnosis | CNOR-007 |
| 41 | A | Infection prevention | CNOR-041 |
| 42 | C | Professional accountabilities | CNOR-050 |
| 43 | A | Intraoperative patient care and safety | CNOR-023 |
| 44 | B | Plan of care and outcomes | CNOR-012 |
| 45 | C | Communication and documentation | CNOR-034 |
| 46 | A | Emergency situations | CNOR-047 |
| 47 | B | Personnel, services and materials | CNOR-029 |
| 48 | D | Assessment and diagnosis | CNOR-008 |
| 49 | A | Infection prevention | CNOR-042 |
| 50 | B | Intraoperative patient care and safety | CNOR-024 |
Turn missed answers into a review list
For each question you missed or guessed on, write one line: what you chose, the principle that made the right answer right, and where you'll check it. The source linked in each explanation is a good place to start. Then retry those questions in a few days, cold.
| Question | What I missed | What I'll review |
|---|---|---|
What this CNOR practice test covers
This set spreads its 50 questions across CCI's subject areas in close proportion to the real exam's 185 scored questions.
| Subject area | Weight on the exam | Scored questions on the exam | Questions in this set |
|---|---|---|---|
| 1. Pre/postoperative Patient Assessment and Diagnosis | 15% | 28 | 8 |
| 2. Individualized Plan of Care Development and Expected Outcome Identification | 8% | 15 | 4 |
| 3a. Management of Intraoperative Activities: Patient Care and Safety | 25% | 46 | 12 |
| 3b. Management of Intraoperative Activities: Management of Personnel, Services and Materials | 9% | 17 | 5 |
| 4. Communication and Documentation | 11% | 20 | 5 |
| 5. Infection Prevention and Control of Environment, Instrumentation and Supplies | 16% | 30 | 8 |
| 6. Emergency Situations | 10% | 19 | 5 |
| 7. Professional Accountabilities | 6% | 10 | 3 |
| Total | 100% | 185 | 50 |
Exam weights and scored-question counts come from the CCI CNOR Handbook, "Subject Areas on the Exam" (p. 5). Area 3 is one subject area with two parts, so there are seven areas, not eight. To get the right-hand column, we scaled each area's scored-question count by 50/185 and rounded with the largest-remainder method so the total stays at 50. That keeps the mix realistic. It doesn't make this a miniature CNOR, and it doesn't cover every task on CCI's full list of task and knowledge statements.
CNOR exam format and the 2027 change
| Row label | Current CNOR exam |
|---|---|
| Questions | 200 multiple-choice questions: 185 scored and 15 unscored pretest questions you can't identify, so answer every question |
| Time | 3 hours 45 minutes |
| Where | PSI test centers (Monday through Saturday) or remote proctored online |
| Breaks | One 10-minute unscheduled break at a test center; no breaks when testing remotely |
| Scoring | Scaled score from 200 to 800; 620 passes. A scaled score is not a percentage or a count of correct answers |
| Results | Pass or fail on screen right away. A passing report has no breakdown; candidates who don't pass get a detailed score report from PSI by email within 24 hours |
| Cost | $475 application fee, which includes the first attempt; $175 for each retake |
| Timing | Take the first attempt within 90 days of approval or it is forfeited. Retakes are allowed within the 12-month eligibility period beginning on application approval, with at least 30 days between attempts |
| Eligibility | Current, unrestricted RN license; currently working in perioperative nursing; at least 2 years and 2,400 hours as a perioperative RN, with at least 1,200 of those hours intraoperative (18 months and 2,400 hours for CFPN, CST, TS-C, or military-equivalent holders) |
Source: CCI CNOR Handbook, updated May 1, 2026 (pp. 5-6, 8, 12-15). CCI's CNOR page confirms these fees and the continuous-testing rules. Candidates with a legacy Take 2 purchase should use the separate legacy provisions in the handbook (p. 9).
How hard is it? In 2025, 68.0% of 3,852 first-time CNOR candidates passed, and 49.7% of 766 retake candidates passed, according to CCI's credential statistics. These are different candidate groups, not a before-and-after result or a prediction for an individual.
What changes in 2027
CCI adopted the results of its 2024 job analysis on November 7, 2024. The new CNOR exam, launching in 2027, reorganizes the content into six competency areas. The number of questions and the time allowed stay the same. In our September 23, 2026 check, CCI's announcement and transition FAQs did not give an exact launch date.
| 2027 competency area | CNOR items |
|---|---|
| 1. Individualized Plan of Care Development | 42 |
| 2. Intraoperative Patient Care and Safety | 49 |
| 3. Management of Personnel, Services, and Materials | 24 |
| 4. Communication and Documentation | 20 |
| 5. Infection Prevention and Control | 33 |
| 6. Emergency Identification and Management | 17 |
| Total | 185 |
What that means for your test date:
- If you test before the new exam launches, you take the current version, which is the one this practice set follows.
- CCI says there will be no overlap period when both versions are offered. A retake taken after the launch uses the new version.
- The current "Pre/postoperative Patient Assessment and Diagnosis" and "Professional Accountabilities" areas are folded into other areas rather than dropped, according to CCI's crosswalk.
Sources: CCI 2024 job task analysis page and transition FAQs.
Frequently asked questions
Are these real CNOR exam questions? No. Every question here is original and written to CCI's published outline. Actual CNOR questions are confidential, and CCI prohibits copying or sharing them (CNOR Handbook, PSI examination guidelines).
What practice score means I'm ready? There's no reliable conversion. CCI turns the number you answer correctly into a 200-800 scaled score so results stay consistent across different exam forms, and a practice percentage doesn't map onto that scale. Use your results here to decide what to study, not to forecast a pass. See the handbook's scoring explanation, p. 15.
How can I plan what to study next? Start with the missed-question review list above and compare those topics with CCI's task and knowledge statements. CCI recommends about three months of study in the CNOR Handbook, p. 12; that is preparation guidance, not an eligibility requirement. It also publishes a free CNOR study plan.
Where are CCI's official sample questions? The handbook includes five sample questions (p. 16) that show the format, and CCI offers five practice questions with rationales through a download form.
Sources and editorial notes
Written by the Castleport Test Prep Editorial Team.
Last verified: September 23, 2026. The exam format, scoring, fees, eligibility, subject areas, and 2027 transition details were checked against the CCI CNOR Handbook (updated May 1, 2026), CCI's CNOR page, CCI's job-analysis pages, and CCI's credential statistics. Each explanation was checked against the source linked beside it. AI tools assisted with drafting, source checking, and editing. These questions have not been reviewed by an outside clinician. They teach general principles; your facility's policies, your state's nurse practice act, and a product's instructions for use govern your actual practice.
Official CNOR sources
- CCI CNOR Candidate Handbook, updated May 1, 2026
- CCI CNOR Task and Knowledge Statements, updated December 2023
- CCI CNOR certification page
- CCI 2024 CNOR and CFPN job task analysis, FAQs, and crosswalk
- CCI credential statistics
Clinical and professional sources used in the explanations
- Joint Commission, National Performance Goals, Hospital Program (effective January 2026), Effective January 2026; report generated September 26, 2025
- CDC, Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008 guideline), 2008 guideline; summary page dated December 7, 2023
- MHAUS, Managing A Crisis: Emergency Treatment for an Acute MH Event, Live MHAUS page
- ASRA Pain Medicine, Checklist for Treatment of Local Anesthetic Systemic Toxicity, 2020, v1.1
- AHRQ TeamSTEPPS, Tool: Teach-Back, Content last reviewed May 2023
- American College of Surgeons, Revised Statement on the Prevention of Unintentionally Retained Surgical Items After Surgery, October 1, 2016
- American Heart Association, Part 7: Adult Basic Life Support (2025 Guidelines for CPR and ECC), 2025 guidelines
- American Society of Anesthesiologists, Statement on Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate Orders, Reaffirmed October 18, 2023
- Anesthesia Patient Safety Foundation, OR Fire Prevention flyer ("Don't Fuel the Fire"), 2014 flyer
- NCSBN and ANA, National Guidelines for Nursing Delegation, 2019 guidelines
- CDC, Preventing Unsafe Injection Practices, March 26, 2024
- Anesthesia Patient Safety Foundation, OR Fire Prevention Algorithm, 2024 algorithm
- CDC NHSN Patient Safety Component Manual, Chapter 9: Surgical Site Infection Event, January 2026
- CDC/HICPAC, 1999 surgical wound classification table, Table 7, printed p. 259. Used only for the traditional class definitions in Question 50; this historical guideline is not cited as current infection-prevention guidance.
How we build and correct pages: methodology · editorial standards · corrections · independence
Castleport Test Prep is an independent exam prep publisher and is not affiliated with, endorsed by, or approved by the Competency & Credentialing Institute (CCI) or PSI. CNOR and other exam and credential names are used only to identify the exams discussed; trademarks belong to their respective owners. These practice questions are original and unofficial, and no score on them guarantees a result on the CNOR exam.