The CCI CNOR (Competency and Credentialing Institute’s Certified Nurse Operating Room) exam is administered by the American Board 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, which is defined as the period before, during and after surgery.

To take the CCI CNOR, one must already hold an unrestricted registered nurse license in the country where they are practicing, currently be working full- or part-time in perioperative nursing, and have at least two years and 2,400 hours of experience in perioperative nursing. Notably, at least 1,200 of these hours must have occurred in an intraoperative setting (during surgery).

The exam, which test takers have 3 hours and 45 minutes to complete, is comprised of 200 multiple-choice questions. Notably, only 185 questions are scored (the other 15 questions are included as pretest questions and may be used on future exams). On the CCI CNOR, one’s correct responses are converted to a scaled score that ranges from 200 to 800; 620 is considered a passing score.

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

1. Preoperative Patient Assessment and Diagnosis 12% 22 questions
2. Plan of Care 10% 19 questions
3. Intraoperative Care 27% 50 questions
4. Communication 10% 18 questions
5. Transfer of Care 6% 11 questions
6. Instrument Processing and Supply Management 9% 17 questions
7. Emergency Situations 11% 20 questions
8. Management of Personnel, Services, and Materials 6% 11 questions
9. Professional Accountability 9% 17 questions

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.

Content Area 1: Preoperative Patient Assessment and Diagnosis

22 questions on the CCI CNOR focus on questions concerned with preoperative patient assessment and diagnosis. Like all parts of the exams, expect to encounter both knowledge and task questions. Specifically, be prepared to respond to knowledge and task questions on the following topics:

i. Knowledge

• Anatomy and physiology
• Pathophysiology
• Pharmacology
• Diagnostic procedures and results
• Health assessment techniques
• Approved nursing diagnoses
• Universal protocol
• Consents (e.g., surgical, anesthesia, blood, photographs)
• Advanced directives and DNR
• Nursing process
• Medication reconciliation protocol

ii. Tasks

• Confirm patient identity using two patient identifiers
• Verify procedure and surgical consent
• Assess Health Status of the Patient
• Formulate nursing diagnoses
• Document preoperative assessment

Content Area 2: Plan of Care

There are 19 questions on the second content area of the CCI CNOR. Under knowledge statements, be prepared to respond to questions about any of the following topics:

• Physiological responses
• Disease processes
• Behavioral responses
• Age-specific needs
• Transcultural nursing theory
• Perioperative safety
• Patient rights
• Resources for patient/family
• Legal responsibilities
• Community and institutional resources
• Patient outcomes
• Standard Precautions
• Preoperative patient

Task-related questions on this section of the exam primarily pertain to subjects regarding the steps one must take to develop a patient care plan, including but not limited to age-specific needs, patient and family needs, and legal implications.

Content Area 3: Intraoperative Care

Intraoperative care includes anything that happens during surgery. This is the most heavily weighted content area on the CCI CNOR exam. Indeed, it accounts for 50 questions in total or more than twice the number of questions found on any other part of the exam. A thorough knowledge of surgical procedures, infection prevention, wound classification, healing and surgical instruments is essential to ace this section of the exam. In addition, test takers must have a strong grasp of intraoperative nursing tasks (e.g. how to monitor and maintain patient and personnel safety during an operation and how to optimize patient care based on behavioral responses).

Content Area 4: Communication

For content area 4, which accounts for 18 questions, test takers should be prepared to respond to questions on interviewing techniques, reporting and using information technologies in compliance with the Health Insurance Portability and Accountability Act (HIPAA). In addition, test takers should expect to come across task-related communication questions (e.g., how best to provide information about patients to family and friends in accordance with HIPAA or how to identify and respond to communication barriers with patients).

Content Area 5: Transfer of Care

Transfer of care questions are concerned with the movement of patients between units and with working on an interdisciplinary care team. The 11 knowledge- and task-related questions on this part of the exam may cover any of the following topics:

• Interdisciplinary services for care coordination
• Transfer of care criteria
• Regulatory guidelines concerning post-operative follow-up
• Collaboration with interdisciplinary services
• Evaluating patient status
• Documenting transfer of care
• Post-discharge follow-ups

Content Area 6: Instrument Processing and Supply Management

17 questions on the exam address technical questions regarding instruments and supplies. Knowledge questions focus on topics that include but are not limited to the following:

• Cleaning techniques and products
• Disinfecting techniques
• Sterilization techniques
• Transportation and storage of equipment, instruments, and supplies
• Hazardous materials exposure
• Documentation requirements for instrument sterilization

Task-related questions aim to probe the test taker’s ability to:

• Select appropriate methods and products for processing
• Perform and document disinfection procedures
• Handle and dispose of hazardous materials
• Handle and dispose of biohazard materials
• Perform and document sterilization procedures
• Monitor environmental conditions of sterilization and storage areas
• Manage materials and instruments provided by external sources

Content Area 7: Emergency Situations

Content Area 7 tests test takers knowledge of the many emergency situations that can and do arise in the context of perioperative nursing. Among other questions, test takers should be prepared to respond to knowledge questions on topics such as preparation for management of medical emergencies, environmental hazards, and natural disasters. Among the total of 20 questions on this section of the exam, test takers should also be prepared to respond to task-oriented questions about how to perform nursing interventions in emergency conditions (e.g., how to support a patient experiencing malignant hyperthermia, cardiac arrest or trauma, or how to coordinate members of an interdisciplinary healthcare team when faced with extreme circumstances from fire to terrorist attacks).

Content Area 8: Management of Personnel, Services, and Materials

11 questions on the CCI CNOR are concerned with the management of personnel, services, and materials. These questions may include questions about how to manage non-medical staff (i.e., vendors, students, visitors, and family), and how to supervise and mentor other healthcare team members, including interns. Other questions on this part of the exam address issues of environmental sustainability and management and personal protection equipment.

Content Area 9: Professional Accountability

Professional accountability, the final section of the CCI CNOR exam, is comprised of 17 questions. This critical part of the exam contains questions about regulations, guidelines, professional responsibilities, and patient rights. The following is a breakdown of just some of the knowledge- and task-related topics that generally appear on the final section of the CCI CNOR exam:

i. Knowledge

• Regulatory standards and guidelines
• Perioperative nurse scope of practice
• Resources for professional growth
• Quality improvement activities
• Patient’s rights and advocacy
• Principles of delegation
• Risk management

ii. Tasks

• Protect patient confidentiality
• Advocate for and protect patients’ rights
• Perform functions within scope of practice
• Demonstrate competency in perioperative nursing practice
• Acknowledge personal limitations and seek assistance as needed
• Identify and take appropriate action regarding behaviors that undermine a culture of safety
• Participate in professional development activities

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

Berry & Kohn’s Operating Room Technique, 12th Edition