Free CNOR Assessment Practice Questions with Answers

Functional capacity is measured in Metabolic Equivalents (METs). Climbing two flights of stairs or walking 4 mph equals ≥4 METs. Clinical Significance: Patients with ≥4 METs generally have a lower risk of perioperative Major Adverse Cardiac Events (MACE). If a patient cannot achieve 4 METs (e.g., unable to walk a block or do light housework), they are at higher risk and may require further cardiac testing, especially for high-risk procedures. CCI Exam Tip: CCI often tests the 4 MET threshold as the dividing line for requiring further diagnostic workup versus proceeding to surgery.

For elective non-cardiac surgery, DAPT (Dual Antiplatelet Therapy) should ideally continue for 6 months after DES placement. If surgery is urgent, it may be considered after 3 months, but never before 30 days. Risk: Premature interruption of DAPT significantly increases the risk of stent thrombosis, myocardial infarction, and death. Rationale: Re-endothelialization of the stent takes time; the perioperative pro-thrombotic state exacerbates this risk. Exam Strategy: Distinguish between Bare Metal Stents (30-day delay) and DES (6-month delay for elective cases).

The RCRI (Lee's Criteria) includes six predictors: 1) High-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular); 2) History of ischemic heart disease; 3) History of congestive heart failure; 4) History of cerebrovascular disease (TIA/Stroke); 5) Preoperative insulin use for diabetes; 6) Preoperative serum creatinine >2.0 mg/dL. Rationale: Each factor equals 1 point. Scores of ≥2 points indicate significantly elevated risk for postoperative MI, cardiac arrest, or complete heart block. CCI Focus: RCRI is the most commonly tested risk stratification tool on the CNOR exam.

The presentation (murmur location/type and syncope) is classic for Aortic Stenosis (AS). Primary Risk: Severe AS is a high-risk condition for non-cardiac surgery, as the fixed cardiac output cannot meet the increased metabolic demands of surgery/anesthesia, leading to sudden hemodynamic collapse or MI. Clinical Pearl: If suspected, an echocardiogram must be performed within 1 year (or sooner if symptoms changed) before proceeding with elective surgery. Distractor: Do not confuse with Mitral Regurgitation (holosystolic murmur at the apex).

Priority: Ensure the device is interrogated and the tachyarrhythmia detection/shocks are disabled (placed in monitor only or asynchronous mode depending on the device) to prevent inappropriate firing due to Electromagnetic Interference (EMI). Nursing Rationale: For procedures above the umbilicus, EMI is a high risk. If the device is disabled, the nurse must ensure a defibrillator and external pacer are immediately available in the OR. Strategy: CCI emphasizes patient safety regarding CIEDs (Cardiac Implantable Electronic Devices) and the need for a formal management plan from the cardiology team.