Mixed Deck — All CRNFA Topics Flashcards

Preoperative marking of the surgical site is performed to prevent which type of adverse surgical event?

Answer: Wrong-site, wrong-side, or wrong-procedure surgery

Surgical site marking is a Joint Commission Universal Protocol requirement specifically designed to prevent wrong-site, wrong-side, and wrong-procedure surgeries.

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

Answer: Cut mode

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

Which type of needle holder is most appropriate when suturing delicate cardiovascular tissue?

Answer: Castroviejo needle holder

The Castroviejo needle holder is a fine, spring-loaded instrument designed for delicate cardiovascular and ophthalmic suturing.

Which suture material is most appropriate for a contaminated abdominal wound requiring fascial closure?

Answer: Polydioxanone (PDS) — monofilament slowly absorbable

Monofilament slowly absorbable sutures like PDS are preferred in contaminated wounds because they provide prolonged tensile strength and their monofilament structure harbors fewer bacteria than braided sutures.

During a laparoscopic procedure, the surgeon asks the CRNFA to adjust the monopolar ESU settings. Which finding on the ESU display indicates that the dispersive pad alarm is activated?

Answer: The contact quality monitor indicator shows poor pad contact

Modern ESUs with contact quality monitoring display a poor contact warning when the dispersive pad has inadequate skin contact, preventing unsafe current return.

A fire has started on the sterile drape from an ESU spark near supplemental oxygen. The CRNFA's immediate priority is to:

Answer: Remove the burning drape from the patient, stop oxygen flow, and extinguish the fire away from the patient

The RACE/PASS OR fire response prioritizes removing the burning material from the patient and cutting off the oxygen supply (the oxidizer) before using an extinguisher away from the patient's airway.

A Harrington ('sweetheart') retractor is most commonly used to retract which structure?

Answer: The liver during upper abdominal surgery

The Harrington retractor, named for its heart-shaped blade, is designed to lift and retract the liver and spleen during upper abdominal procedures.

The CRNFA observes sudden masseter muscle rigidity after succinylcholine administration during intubation. This finding should prompt concern for which emergent condition?

Answer: Malignant hyperthermia

Masseter muscle rigidity (jaw rigidity) following succinylcholine is an early and classic warning sign of malignant hyperthermia and requires immediate activation of the MH protocol.

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

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.

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

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.

Electrosurgical unit (ESU) current density is highest at which point in the circuit?

Answer: The active electrode tip

Current density is highest at the small active electrode tip where tissue effect (cutting or coagulation) occurs, and lowest at the large dispersive pad where current spreads safely.

A patient on therapeutic anticoagulation with warfarin undergoes emergency surgery. Intraoperatively, the CRNFA observes persistent oozing from tissue planes. Which agent is most appropriate to request for pharmacologic hemostasis?

Answer: Fresh frozen plasma (FFP)

Fresh frozen plasma contains all clotting factors and is the preferred reversal agent for warfarin-induced coagulopathy in emergency surgery.

Prolonged prone stance has the following risks:

Answer: Eye injury including temporary or permanent blindness

In the prone position, especially during prolonged surgeries, the eyes are vulnerable to direct pressure, which can compromise ocular blood flow. This sustained pressure can lead to ischemic optic neuropathy, resulting in temporary or permanent vision loss or even blindness. Careful positioning, frequent checks, and appropriate head support are crucial to prevent this severe complication.

When handling instruments that have been exposed to Creutzfeldt-Jakob disease (CJD) prions, standard sterilization with steam autoclave is:

Answer: Insufficient; prions require specialized decontamination protocols

Prions are not inactivated by standard steam sterilization or chemical disinfectants; WHO and CDC recommend instrument destruction or highly specialized alkaline/autoclaving protocols.

An ASA Class III patient is best described as having which condition?

Answer: A patient with severe systemic disease causing substantive functional limitations

ASA Class III describes a patient with severe systemic disease that causes substantive functional limitations but is not incapacitating.

Intraoperative hypothermia (core temperature < 36°C) increases the risk of which complication most significantly?

Answer: Surgical site infection and coagulopathy

Hypothermia impairs neutrophil oxidative killing, causes vasoconstriction reducing tissue oxygenation, and inhibits coagulation enzyme function, tripling SSI risk and promoting coagulopathy.

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

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.

Which vessel-sealing device uses bipolar energy combined with pressure to create a permanent seal on vessels up to 7 mm in diameter?

Answer: LigaSure

LigaSure uses bipolar radiofrequency energy and mechanical pressure to denature collagen and elastin, creating a permanent seal on vessels up to 7 mm.

Which suture technique is most appropriate for ligating the pedicle of the appendix at its base?

Answer: Simple ligation with a free tie

The appendiceal stump is typically managed with a simple free tie (ligation) or endoloop at its base to secure the mesoappendix vessels and prevent bleeding.

Bone wax is most appropriately used to control bleeding from which type of source?

Answer: Bleeding from cancellous bone surfaces (e.g., sternum or cranium)

Bone wax is a mechanical hemostatic agent used specifically to tamponade bleeding from cut bone surfaces such as the sternum during cardiac surgery or the cranium during neurosurgery.