The American Board administers the Competency and Credentialing Institute’s CNOR exam for Specialty Nursing Certification. While not required, the credential formally recognizes a nurse’s specialized knowledge, experience, and skills in providing nursing care to patients during the perioperative period, defined as before, during, and after surgery.

To take the CCI CNOR exam, candidates must:

  • Hold an unrestricted registered nurse license in the country where they practice.
  • Currently work full-time or part-time in perioperative nursing.
  • Have at least two years and 2,400 hours of experience in perioperative nursing, with at least 1,200 of these hours in an intraoperative setting (during surgery).

The exam consists of 200 multiple-choice questions, which must be completed within 3 hours and 45 minutes. Only 185 of these questions are scored; the remaining 15 are pretest questions that may be used in future exams. The correct responses are converted to a scaled score ranging from 200 to 800, with a passing score being 620.

There are seven subject areas on the exam. Each subject area contains both knowledge and task-oriented questions. The specific breakdown of the CNOR exam is as follows:

  • Subject Area 1: Pre/Postoperative Patient Assessment and Diagnosis: 15% / 22 questions
  • Subject Area 2: Individualized Plan of Care Development and Expected Outcome Identification: 8% / 12 questions
  • Subject Area 3: Management of Intraoperative Activities: 34% / 51 questions
  • Subject Area 4: Communication and Documentation: 11% / 16 questions
  • Subject Area 5: Infection Prevention and Control of the Environment, Instrumentation, & Supplies: 16% / 24 questions
  • Subject Area 6: Emergency Situations: 10% / 15 questions
  • Subject Area 7: Professional Accountability: 6% / 9 questions

Check out the full CNOR Study Plan.

To ace the CCI CNOR, you’ll need a combination of knowledge and experience and an understanding of the test structure itself. Below, we outline the key parts of the exam and provide tips on how to structure your study plan.

Subject Area 1: Pre/Postoperative Patient Assessment and Diagnosis

  1. Confirm patient identity with two (2) patient identifiers, confirm correct procedure, operative site, side/site marking with a completed appropriate consent
  2. Review relevant patient data, review medication reconciliation
  3. Use age and culturally appropriate health assessment techniques
  4. Conduct an individualized physical and psychosocial assessment, obtain a focused assessment relevant to the procedure, perform a pain assessment
  5. Identify nursing diagnoses
  6. Confirm advance directive status and/or DNR status
  7. Conduct patient and family teaching as appropriate for the procedure

Subject Area 2: Individualized Plan of Care Development and Expected Outcome Identification

  1. Identify measurable patient outcomes across the continuum of care, identify specific interventions for each nursing diagnosis to achieve expected outcomes
  2. Ensure care plan addresses specific patient considerations
  3. Evaluate patient responses to plan of care, update plan of care as needed
  4. Utilize critical thinking skills to facilitate patient care

Subject Area 3: Management of Intraoperative Activities

3.a. Patient Care and Safety

  1. Maintain patient and personnel safety by monitoring environmental hazards
  2. Provide comfort measures to optimize behavioral responses to the surgical procedure
  3. Prepare the surgical site per procedure and surgeon preference, ensure the selection of appropriate procedure-specific barrier materials
  4. Evaluate patient response to pharmacological agents, assist with anesthesia management
  5. Control environmental factors
  6. Maintain a sterile field utilizing aseptic technique
  7. Utilize equipment according to manufacturer’s recommendations
  8. Maintain the dignity and privacy of the patient
  9. Protect patients’ rights through advocacy
  10. Verify that specimens are prepared, labeled, and transported correctly, verify that the correct implants are available, verify that the implants are correctly prepared, prepare explants for final disposition
  11. Label solutions, medications, and medication containers
  12. Perform appropriate surgical counts, perform Universal Protocol
  13. Anticipate the need for intraoperative blood transfusion/salvage
  14. Utilize proper body mechanics, perform proper patient positioning appropriate for procedure
  15. Intervene with impaired/disruptive behavior in patients, family members, and/or the perioperative team
  16. Identify wound classifications
  17. Maintain wound dressings, including tubes, lines, and drains

3.b. Management of Personnel, Services, and Materials

  1. Acquire needed equipment, supplies, and personnel, assess expiration date and package integrity of products
  2. Implement cost-containment measures
  3. Participate in product evaluation/selection
  4. Provide supervision of and education to healthcare team members, delegate tasks to appropriate personnel according to regulatory agencies and facility policies
  5. Supervise visitors, manage healthcare industry representative presence in the OR
  6. Practice environmental stewardship

Subject Area 4: Communication and Documentation

  1. Maintain accurate patient records/documentation of all care provided
  2. Collaborate with the interdisciplinary healthcare team, communicate current patient status to interdisciplinary healthcare providers, communicate measurable patient outcomes across the continuum of care
  3. Document perioperative education provided to the patient and advocate where applicable
  4. Document post discharge follow up communication provided to patient
  5. Document preoperative and postoperative assessment, document transfer of care, document appropriate measures to prepare and track implantable tissue and other trackable items, document surgical wound classification
  6. Evaluate patient status to facilitate transfer to the next level of care
  7. Implement effective solutions to identified patient communication barriers
  8. Provide information about the patient according to HIPAA guidelines
  9. Utilize read-back for verbal orders

Subject Area 5: Infection Prevention and Control of the Environment, Instrumentation, & Supplies

  1. Ensure proper environmental cleaning for spills, room turnover, and/or terminal cleaning
  2. Ensure appropriate methods for cleaning, disinfecting, packaging, sterilizing, transporting and/or storage of instruments and reusable goods, ensure appropriate methods for transporting and storage of single-use items
  3. Maintain appropriate documentation for sterilization and disinfection
  4. Ensure proper handling and disposition of hazardous materials, ensure proper handling and disposition of biohazard materials
  5. Utilize appropriate Personal Protective Equipment (PPE)
  6. Adhere to appropriate procedures for sterilization, biological monitoring, and chemical monitoring
  7. Monitor environmental conditions of sterilization and storage areas
  8. Track materials and instruments brought in from outside the facility
  9. Adhere to guidelines regarding proper surgical attire based on restricted, semi-restricted, and non-restricted zones, adhere to proper hand hygiene guidelines, including surgical hand scrubbing

Subject Area 6: Emergency Situations

  1. Identify emergency situations, including difficult airway, robotic
  2. Perform nursing interventions for malignant hyperthermia (MH), anaphylaxis, cardiac arrest, trauma, hemorrhage, local anesthetic systemic toxicity (LAST)
  3. Function as a member of the interdisciplinary healthcare team
  4. Safeguard patients and members of the healthcare team from environmental hazards and during disasters

Subject Area 7: Professional Accountability

  1. Function within scope of practice
  2. Seek assistance for recognized personal limitations
  3. Report impaired/disruptive behavior in interdisciplinary healthcare team
  4. Uphold ethical and professional standards
  5. Utilize resources for personal growth
  6. Participate in quality improvement activities, interdisciplinary teams, professional organizations

Due to the complexity of the exam, you should plan to study for the CCI CNOR exam for at least three months. Try Pocket Prep’s CCI CNOR exam prep app and study with the referenced textbooks!