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CNOR: Medications & Solutions

Safe medication handling on the sterile field prevents serious errors. These CNOR questions cover labeling, local anesthetics, irrigation solutions, and safe handling — each with a full rationale.

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  • 💡 Key Takeaways — the one transferable rule per question
  • 🔍 Hint highlights — the decisive cue phrases in each stem
  • 📖 Full rationales — why every option is right or wrong

Every CNOR question is written to the current exam outline for quick learning and a clear pass strategy.

Written and reviewed by the LexPort exam-prep team, led by our Founder & Exam-Prep Lead. LexPort builds certification practice questions — this is exam-preparation material, not medical advice. Last reviewed August 2026.

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Three CNOR practice questions on cnor: medications & solutions — tap an answer for instant feedback. The app has 2,200+, timed and scored.

Question 1

The scrub person is drawing medication from a multi-dose vial using a sterile syringe and needle. The circulator holds the vial inverted over the sterile field. Which action must occur to maintain aseptic technique during this transfer?

▸ Why A is the answer

When drawing medication from a vial held by the circulator, the circulator must disinfect the rubber stopper with isopropyl alcohol and allow it to dry completely before the scrub person inserts the needle. This critical step prevents contamination of the sterile needle and the multi-dose vial contents. Injecting sterile air into the vial is generally avoided in this specific sterile-to-unsterile transfer technique because it can aerosolize the medication or contaminate the vial if the air isn't perfectly sterile. Removing the rubber stopper compromises the entire vial and immediately breaks sterility. Labeling the syringe before drawing the medication is incorrect; labels should be applied immediately after the medication is drawn to ensure the label matches the actual volume and substance in the syringe, preventing a dangerous labeling mismatch.

🔑 Key takeaway

Vial stoppers must be disinfected with alcohol and allowed to dry before a sterile needle is inserted.

Question 2

A circulating RN observes a certified surgical technologist independently drawing up unlabeled medication from a vial held by the anesthesia provider during a rapid trauma laparotomy.

▸ Why B is the answer

The RN must intervene because the surgical technologist's scope requires the RN to verify all medications transferred to the sterile field, regardless of urgency. Option B is correct as it ensures patient safety and adherence to scope. Option A is incorrect because emergencies do not negate the need for proper medication verification. Option C is wrong because passive documentation fails to prevent a potential immediate medication error. Option D is incorrect because unsterile vials cannot be placed directly onto the sterile backtable.

🔑 Key takeaway

Perioperative nurses must verify all medications transferred to the sterile field regardless of procedural urgency.

Question 3

While performing the skin prep for a total knee arthroplasty, the nurse observes raised, erythematous blistering extending across the patient's thigh immediately after applying the chlorhexidine gluconate solution.

▸ Why C is the answer

The sudden appearance of erythematous blistering indicates a severe contact dermatitis or allergic reaction to the prep solution. The nurse must modify the care plan by halting the prep to prevent further tissue damage or systemic anaphylaxis and notifying the surgeon. Option A is incorrect because applying another chemical agent without orders or team discussion could exacerbate the reaction. Option B ignores a critical intraoperative finding, placing the patient at high risk for severe postoperative skin complications. Option D is outside the nurse's independent scope and unsafe as it continues applying the offending agent.

🔑 Key takeaway

Immediate hypersensitivity reactions during skin prep require halting the procedure to prevent severe complications.

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Question 1

A perioperative nurse is preparing to manually clean and immerse flexible endoscopes in an ortho-phthalaldehyde (OPA) solution. Which personal protective equipment combination is most appropriate for this task?

  • A) Don heavy-duty nitrile gloves and a full face shield.✓
  • B) Don standard sterile latex gloves and a full face shield.
  • C) Don heavy-duty nitrile gloves and a standard surgical mask.
  • D) Don standard sterile latex gloves and a standard surgical mask.

💡 Key Takeaway

Handling high-level disinfectants requires chemical-resistant gloves and full eye protection to prevent toxic exposure.

Show rationale

OPA and glutaraldehyde require specific PPE because they easily penetrate standard materials. The nurse must wear heavy-duty nitrile gloves or butyl rubber gloves, as standard latex gloves offer inadequate chemical resistance. Additionally, a full face shield or chemical splash goggles are required to protect the mucous membranes from splashes, making a standard surgical mask alone insufficient. Option A correctly identifies both the appropriate chemical-resistant gloves and the necessary eye protection. Options B and D incorrectly suggest latex gloves, which allow chemical breakthrough. Options C and D incorrectly rely on a surgical mask, which does not provide adequate splash protection for the eyes.

Question 2

A preference card for a total knee arthroplasty requests a specific non-formulary antimicrobial irrigation. However, the facility recently implemented a standardized joint infection protocol utilizing a different, approved solution. How should the nurse proceed?

  • A) Clarify the irrigation choice with the surgeon before opening.✓
  • B) Open the non-formulary irrigation as listed on the card.
  • C) Provide the standardized solution without notifying the surgeon.
  • D) Ask the hospital pharmacist to approve the non-formulary use.

💡 Key Takeaway

When preference cards conflict with new facility protocols, direct communication with the surgeon ensures compliance and patient safety.

Show rationale

Preference cards often lag behind the implementation of new hospital policies. When a conflict arises between a surgeon's historical preference and a new standardized protocol, the nurse must facilitate direct communication to clarify the plan before opening supplies. Opening the non-formulary irrigation (Option B) violates the new facility protocol and may result in wasted supplies if the surgeon intended to follow the new standard. Providing the standardized solution without notifying the surgeon (Option C) undermines the surgeon's autonomy and could lead to intraoperative frustration or adverse reactions if the patient has specific contraindications. Asking the pharmacist to approve the non-formulary use (Option D) bypasses the surgeon, who is ultimately responsible for the clinical decision regarding which irrigation is appropriate for their specific patient.

Question 3

While preparing medications for a local anesthetic mixture, the circulator drops a partially full vial of epinephrine and needs to discard it along with the drawn-up unused medication. Which disposal method is required?

  • A) Discard the items into the standard red biohazard bag.
  • B) Empty the remaining fluid into the pharmaceutical sink.
  • C) Dispose of the items in a black hazardous waste bin.✓
  • D) Place the intact items into the standard sharps container.

💡 Key Takeaway

Epinephrine is a P-listed medication requiring disposal in a Resource Conservation and Recovery Act black bin.

Show rationale

Epinephrine is classified as a P-listed acutely hazardous waste under the Resource Conservation and Recovery Act. Because the vial is partially full, it is considered bulk hazardous pharmaceutical waste and must be discarded in a black hazardous waste bin to prevent environmental contamination. Discarding these items into a standard red biohazard bag is incorrect because red bags are strictly for infectious or blood-contaminated waste, not chemical hazards. Emptying the fluid into a sink is illegal, as it introduces acutely hazardous pharmaceuticals directly into the municipal water supply. Placing the items into a standard sharps container is also inappropriate, as standard sharps containers are typically incinerated or autoclaved as infectious waste, which does not meet the stringent environmental processing requirements for P-listed hazardous pharmaceutical chemicals.

Question 4

A perioperative nurse is training a new environmental services technician on disinfecting overhead surgical lights during terminal cleaning. The technician prepares to spray a quaternary ammonium solution directly onto the light fixtures.

  • A) Instruct the technician to apply the chemical to a cloth before wiping.✓
  • B) Verify that the technician wears a face shield before spraying the lights.
  • C) Allow the technician to proceed if the lights are completely powered off.
  • D) Recommend using an aerosolized bleach solution instead of the quaternary ammonium.

💡 Key Takeaway

Disinfectants should be applied to a cloth rather than sprayed directly onto surfaces to prevent aerosolization and damage.

Show rationale

Disinfectants should never be sprayed directly onto overhead structures or electrical equipment. Direct spraying creates a risk of inhalation exposure through aerosolization and allows fluid to seep into electrical components, potentially causing damage or fire. Option A correctly mitigates this by applying the chemical to a cloth first. Options B, C, and D all permit or encourage spraying, which violates environmental cleaning guidelines regardless of PPE or power status.

Question 5

During a total knee arthroplasty, the nurse notes that irrigation fluid pools and causes strike-through on the sterile back table drape. How should the nurse manage this contamination?

  • A) Place a sterile towel over the wet drape area.
  • B) Move the sterile instruments away from the wet area.
  • C) Suction the pooled fluid and continue the surgical case.
  • D) Discard the contaminated items and establish a new table.✓

💡 Key Takeaway

Fluid strike-through destroys the sterile barrier, requiring replacement of the affected drapes and contaminated items.

Show rationale

When irrigation fluid pools and causes strike-through on a sterile drape, the sterile barrier is breached, allowing microorganisms to migrate from the unsterile surface below. The affected area and any items on it are considered contaminated. The best action is to establish a new table or completely replace the affected barrier and contaminated instruments. Option A is incorrect because a sterile towel is not impervious and will not stop the wicking action of the fluid. Option B is insufficient because the entire barrier integrity is compromised, and simply moving items does not address the breach. Option C ignores the contamination event entirely, putting the patient at high risk for a surgical site infection by allowing unsterile moisture to remain on the field.

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CNOR · Exam Simulator

A perioperative nurse is preparing to manually clean and immerse flexible endoscopes in an ortho-phthalaldehyd…

A) Don heavy-duty nitrile gloves and a full
B) Don standard sterile latex gloves and a
C) Don heavy-duty nitrile gloves and a stan
D) Don standard sterile latex gloves and a
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