Certified Registered Nurse First Assistant (CRNFA) — Questions and Answers

Question 1: When tying a square knot during wound closure, the CRNFA notices the knot is sliding rather than locking. This most likely indicates:

The suture was moistened before tying
The suture material is too thick for the tissue
The throws were made in the same direction, creating a slip knot (Correct answer)
Excessive tension was applied to the first throw

Correct answer: The throws were made in the same direction, creating a slip knot

A granny (slip) knot results when both throws are in the same direction; a square knot requires alternating throw directions.

Question 2: CCI was formerly known by which name before rebranding as the Competency and Credentialing Institute?

American Board of Perioperative Nursing (ABPN)
AORN Credentialing Center
Perioperative Nursing Certification Corporation (PNCC)
National Certification Board: Perioperative Nursing (NCBPN) (Correct answer)

Correct answer: National Certification Board: Perioperative Nursing (NCBPN)

CCI was previously called the National Certification Board: Perioperative Nursing (NCBPN) before adopting its current name to reflect its broader mission.

Question 3: Which preoperative assessment finding in a female patient of reproductive age requires documentation and possible further action before elective abdominal surgery?

Regular use of multivitamins
History of tonsillectomy as a child
Possibility of pregnancy — last menstrual period unknown (Correct answer)
Mild scoliosis

Correct answer: Possibility of pregnancy — last menstrual period unknown

Unknown or possible pregnancy must be investigated with a pregnancy test before elective abdominal or pelvic surgery to protect the fetus from anesthesia, radiation, and surgical trauma.

Question 4: The CRNFA identifies a Metzenbaum scissors on the instrument table. Its PRIMARY use is for:

Cutting suture material
Dissecting delicate tissue (Correct answer)
Cutting heavy fascia and tissue
Opening skin incisions

Correct answer: Dissecting delicate tissue

Metzenbaum scissors have long, slender blades designed for dissecting and cutting delicate tissue, not for cutting suture.

Question 5: Under CCI's requirements, which of the following best describes the eligibility criterion related to first assisting hours before sitting for the CRNFA exam?

1,500 hours within the past 5 years
750 hours within the past 1 year
2,000 hours within the past 3 years
500 hours within the past 2 years (Correct answer)

Correct answer: 500 hours within the past 2 years

CCI requires documentation of a minimum of 500 hours of first assisting experience within the 2 years preceding application.

Question 6: Which wound closure device provides the fastest skin closure and lowest rate of tissue strangulation in linear wounds?

Steri-Strips (skin closure tapes)
Interrupted monofilament sutures
Subcuticular absorbable suture
Skin staples (Correct answer)

Correct answer: Skin staples

Skin staples provide the fastest mechanical closure with minimal tissue handling and low risk of strangulation because they do not incorporate tissue within a loop under tension.

Question 7: Which blood supply to the sigmoid colon is most commonly divided during sigmoid colectomy?

Inferior mesenteric artery branches (sigmoid arteries) (Correct answer)
Right colic artery
Superior rectal artery only
Middle colic artery

Correct answer: Inferior mesenteric artery branches (sigmoid arteries)

The sigmoid colon is supplied by sigmoid arteries (sigmoidal branches of the inferior mesenteric artery) which are divided during sigmoid colectomy.

Question 8: For CRNFA renewal, CCI allows candidates to demonstrate continued competency through what alternative to accumulating 20 CE hours?

Publishing a peer-reviewed article on surgical assistance
Retaking and passing the CRNFA examination (Correct answer)
Submitting a peer evaluation form signed by two surgeons
Completing a CCI-sponsored simulation lab

Correct answer: Retaking and passing the CRNFA examination

Retaking and passing the CRNFA exam is an accepted alternative pathway for renewal, demonstrating current knowledge competency in lieu of CE hours.

Question 9: A Weitlaner retractor is best described as:

A self-retaining retractor with sharp or blunt rake-like prongs (Correct answer)
A ribbon/malleable retractor shaped by the surgeon
A hand-held, smooth-tipped retractor for superficial wounds
A deep pelvic retractor requiring an assistant

Correct answer: A self-retaining retractor with sharp or blunt rake-like prongs

The Weitlaner is a self-retaining retractor with outward-spreading ratcheted arms tipped with blunt or sharp prongs, commonly used in small incisions.

Question 10: CCI policy states that a candidate who fails the CRNFA exam may retest after what minimum waiting period?

30 days
6 months
60 days
90 days (Correct answer)

Correct answer: 90 days

CCI requires a minimum waiting period of 90 days before a candidate who did not pass may retake the CRNFA examination.

Question 11: The Triangle of Calot is bounded by which structures?

Liver, cystic duct, hepatic duct
Liver, cystic artery, common bile duct
Cystic duct, common hepatic duct, liver edge (Correct answer)
Cystic duct, portal vein, hepatic artery

Correct answer: Cystic duct, common hepatic duct, liver edge

The Triangle of Calot is defined by the cystic duct inferiorly, the common hepatic duct medially, and the liver edge superiorly, and contains the cystic artery.

Question 12: The CRNFA is using an argon beam coagulator (ABC). A key safety precaution specific to this device is:

Soaking the tip in saline before use
Ensuring the patient's dispersive electrode is removed before activation
Maintaining low gas flow to prevent pneumoperitoneum in laparoscopy (Correct answer)
Never using it near the bowel

Correct answer: Maintaining low gas flow to prevent pneumoperitoneum in laparoscopy

In laparoscopic procedures, argon gas from the ABC can rapidly increase intraabdominal pressure, causing pneumoperitoneum complications; gas evacuation must be managed carefully.

Question 13: Which of the following is a recognized role of the CRNFA that distinguishes them from a scrub technician?

Passing instruments from the sterile field
Providing tissue retraction, hemostasis, and suturing under surgeon direction (Correct answer)
Counting sponges and sharps with the circulator
Documenting intraoperative events in the nursing record

Correct answer: Providing tissue retraction, hemostasis, and suturing under surgeon direction

The CRNFA actively assists at the surgical field by retracting tissue, controlling bleeding, and suturing—tasks beyond the scope of a scrub technician.

Question 14: Dantrolene sodium is the definitive treatment for malignant hyperthermia. What is the initial recommended IV bolus dose?

0.5 mg/kg
2.5 mg/kg, repeated up to 10 mg/kg total if needed (Correct answer)
10 mg/kg as a single bolus
5 mg/kg once

Correct answer: 2.5 mg/kg, repeated up to 10 mg/kg total if needed

The initial dantrolene dose is 2.5 mg/kg IV bolus, repeated every 5 minutes up to 10 mg/kg (or until symptoms resolve) for malignant hyperthermia treatment.

Question 15: During a laparoscopic cholecystectomy, the CRNFA notices the surgeon is applying excessive traction on the cystic duct before the critical view of safety is achieved. What is the most appropriate action?

Immediately cut the structure as directed
Request the anesthesiologist to alter the patient's position
Document the concern and proceed without intervention
Verbally communicate the concern and recommend pausing to identify anatomy (Correct answer)

Correct answer: Verbally communicate the concern and recommend pausing to identify anatomy

The CRNFA must advocate for patient safety by communicating concerns about anatomic identification before irreversible actions are taken.

Question 16: AORN's Recommended Practice for Sterile Technique states that a sterile field is considered contaminated when:

Sterile saline is poured into a sterile basin
A sterile item falls below the level of the sterile field table (Correct answer)
The surgeon repositions within the sterile field
A scrub person touches a sterile item with sterile gloves

Correct answer: A sterile item falls below the level of the sterile field table

Items that fall below the table edge or waist level are considered contaminated per AORN sterile technique guidelines.

Question 17: Which preoperative vital sign finding requires immediate escalation before a patient is brought into the OR?

Oxygen saturation of 97% on room air
Heart rate of 78 bpm
Temperature of 38.9°C (102°F) (Correct answer)
Blood pressure of 130/80 mmHg

Correct answer: Temperature of 38.9°C (102°F)

A fever of 38.9°C may indicate active infection, which is a contraindication to elective surgery and must be reported immediately.

Question 18: According to AORN guidelines, which type of instrument count should be performed before the surgical incision is closed?

Only sponge counts are required before closure
Sharps counts are performed only when the surgeon requests them
All sponge, sharps, and instrument counts must be reconciled and documented (Correct answer)
Counts are only required for procedures lasting more than two hours

Correct answer: All sponge, sharps, and instrument counts must be reconciled and documented

AORN requires a complete reconciliation of all sponge, sharps, and instrument counts before wound closure to prevent retained surgical items.

Question 19: Which patient factor is the single greatest systemic risk factor for surgical site infection?

Age over 65
Obesity (BMI > 30)
Uncontrolled diabetes mellitus (HbA1c > 8%) (Correct answer)
Smoking within the past year

Correct answer: Uncontrolled diabetes mellitus (HbA1c > 8%)

Uncontrolled diabetes mellitus impairs leukocyte function, reduces tissue perfusion, and provides a glucose-rich environment for bacterial growth, making it the strongest systemic SSI risk factor.

Question 20: A patient undergoing elective hip replacement has a preoperative hemoglobin of 9.5 g/dL. The CRNFA's most appropriate action is to:

Proceed without concern as this is within normal limits
Administer iron supplementation per standing order
Notify the surgeon and anesthesiologist and document the finding (Correct answer)
Cancel the surgery without consulting the surgeon

Correct answer: Notify the surgeon and anesthesiologist and document the finding

A hemoglobin of 9.5 g/dL represents anemia that increases transfusion risk; the CRNFA should notify the surgeon and anesthesiologist so they can decide whether to proceed or optimize the patient.

Question 21: During a video-assisted thoracoscopic surgery (VATS) lobectomy, the patient's oxygen saturation suddenly drops and breath sounds disappear on the operative side. The CRNFA should first suspect:

CO2 embolism from thoracoscopic port insufflation
Pulmonary artery injury with hemorrhage
Endobronchial tube migration causing single-lung ventilation failure (Correct answer)
Tension pneumothorax on the contralateral side

Correct answer: Endobronchial tube migration causing single-lung ventilation failure

Double-lumen endobronchial tube migration can cause loss of lung isolation and ventilation failure, and is a common cause of sudden desaturation in VATS procedures.

Question 22: Which electrosurgical mode uses a continuous waveform to achieve tissue cutting with minimal hemostasis?

Coagulation mode
Cut mode (Correct answer)
Blend mode
Bipolar mode

Correct answer: Cut mode

The cut mode delivers a continuous, unmodulated waveform that rapidly vaporizes tissue, producing a clean cut with minimal lateral thermal spread.

Question 23: When using a monopolar electrosurgical unit (ESU), the dispersive electrode (grounding pad) should be placed:

Over a large muscle mass with good vascularity, as close to the site as practical (Correct answer)
On any dry, clean skin surface chosen for convenience
On the patient's chest regardless of operative site
On a bony prominence near the operative site

Correct answer: Over a large muscle mass with good vascularity, as close to the site as practical

The dispersive electrode must be placed over a large, well-vascularized muscle mass near the operative site to ensure complete current return and prevent burns.

Question 24: The CRNFA should ensure that which safety device is applied before draping to minimize risk of patient movement causing injury during positioning under anesthesia?

Heating blanket
Safety strap or padded restraint securing the patient to the table (Correct answer)
Electrosurgical return pad
Sequential compression devices

Correct answer: Safety strap or padded restraint securing the patient to the table

A safety strap or padded restraint must be applied across the patient's thighs before draping to prevent falls if the patient moves, is inadvertently bumped, or the table is repositioned.

Question 25: The sphincter of Oddi controls flow at the junction of which structures?

Common bile duct and pancreatic duct at the ampulla of Vater (Correct answer)
Gallbladder and cystic duct
Cystic duct and common bile duct
Pancreatic duct and duodenum separately

Correct answer: Common bile duct and pancreatic duct at the ampulla of Vater

The sphincter of Oddi is a smooth muscle sphincter at the ampulla of Vater controlling the flow of bile and pancreatic juice into the duodenum.

Question 26: The McBurney's point, commonly used in appendectomy, is located where?

One-third the distance from the right ASIS to the umbilicus (Correct answer)
One-half the distance from the pubic symphysis to the right ASIS
Midway between the umbilicus and the right ASIS
One-third the distance from the umbilicus to the right anterior superior iliac spine

Correct answer: One-third the distance from the right ASIS to the umbilicus

McBurney's point is located one-third of the distance from the right anterior superior iliac spine to the umbilicus, overlying the base of the appendix.

Question 27: During a right colectomy, which structure lies in close proximity to the ileocolic vessels and must be identified to avoid injury?

Right gonadal vein
Right renal vein
Superior mesenteric vein
Right ureter (Correct answer)

Correct answer: Right ureter

The right ureter runs retroperitoneally along the psoas muscle near the ileocolic vessels and must be identified before ligation during right colectomy.

Question 28: When the RNFA performs tissue retraction during surgery, AORN guidelines emphasize which primary consideration?

Retraction time is irrelevant as long as the surgical field is visible
Applying maximum retraction force to optimize the surgeon's exposure
Using the least amount of pressure necessary to avoid ischemia and nerve injury (Correct answer)
Retractor placement is solely the surgeon's responsibility, not the RNFA's

Correct answer: Using the least amount of pressure necessary to avoid ischemia and nerve injury

AORN's first assistant guidelines stress minimizing retraction pressure and duration to prevent pressure-related tissue ischemia and nerve damage.

Question 29: AORN's Guideline for a Safe Environment of Care recommends that OR traffic be restricted primarily to reduce the risk of:

Communication errors between surgical team members
Delays in instrument delivery from central sterile processing
Surgical site infection by minimizing air turbulence and particulate contamination (Correct answer)
Equipment theft during lengthy procedures

Correct answer: Surgical site infection by minimizing air turbulence and particulate contamination

AORN restricts OR traffic because each door opening disrupts laminar airflow and increases airborne particulates that elevate surgical site infection risk.

Question 30: CCI's mission statement focuses on which primary goal relevant to surgical patient care?

Expanding the scope of practice for all surgical nurses beyond state board regulations
Standardizing perioperative nursing curricula across all US nursing schools
Lobbying Congress for independent practice authority for CRNFAs nationwide
Promoting public confidence in perioperative nursing by validating competency through credentialing (Correct answer)

Correct answer: Promoting public confidence in perioperative nursing by validating competency through credentialing

CCI's core mission is to protect the public by validating and credentialing competency in perioperative nursing practice.

Question 31: A patient with a known latex allergy is scheduled for surgery. The CRNFA should verify that which item is replaced with a latex-free alternative?

Foley catheter and drainage tubing (Correct answer)
Stainless steel retractors
Electrosurgical dispersive electrode cable
Cautery pencil holster

Correct answer: Foley catheter and drainage tubing

Foley catheters and drainage tubing traditionally contain latex and must be substituted with latex-free alternatives in sensitized patients.

Certified Registered Nurse First Assistant (CRNFA)

The CRNFA exam assesses experienced registered nurse first assistants on their competency in intraoperative surgical techniques, perioperative patient assessment, basic sciences, and professional practice. It is administered by the National Assistant at Surgery Certification (NASC).

Questions

35 min

Time Limit

70%

To Pass

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