CFA First-Assist Surgical Roles 3 — Questions and Answers
Question 1: During electrosurgery, the first assistant notices the active electrode is near a metal retractor. What should be done?
- Continue the procedure since metal is grounded
- Reposition the electrode or retractor to prevent unintended energy transfer (Correct answer)
- Increase the electrosurgery unit power to compensate
- Remove the retractor immediately from the field
Correct answer: Reposition the electrode or retractor to prevent unintended energy transfer
Proximity of the active electrode to metal instruments can cause capacitive coupling and inadvertent burns, requiring repositioning.
Question 2: The first assistant is knot-tying using a square knot. Which sequence is correct?
- Right over left, right over left
- Right over left, then left over right (Correct answer)
- Left over left, then right over right
- Loop-knot followed by a single throw
Correct answer: Right over left, then left over right
A square knot requires alternating throws: right over left, then left over right, to lie flat and hold securely.
Question 3: Which statement about the first assistant's role in wound closure is accurate?
- The first assistant should always close the skin independently of the surgeon
- The first assistant assists with fascial and skin closure as directed by the surgeon (Correct answer)
- Wound closure is exclusively the scrub technician's responsibility
- The first assistant only provides suture material and does not participate in closure
Correct answer: The first assistant assists with fascial and skin closure as directed by the surgeon
The first assistant participates actively in closure of fascia and skin layers under the surgeon's direction.
Question 4: A surgeon requests the first assistant to place a purse-string suture around a stapler anvil. What is the purpose?
- To secure the anastomosis staple line against leakage (Correct answer)
- To mark the resection margin for pathology
- To occlude the bowel lumen prior to resection
- To approximate skin edges at the trocar site
Correct answer: To secure the anastomosis staple line against leakage
A purse-string suture around a circular stapler anvil invaginates tissue to create a secure, leak-resistant anastomosis.
Question 5: What does the first assistant do immediately after the surgeon ligates a major vessel?
- Remove the ligation suture and reapply it tighter
- Verify hemostasis by observing the ligation site while maintaining exposure (Correct answer)
- Irrigate the area with saline to test the ligation
- Document the vessel name and time of ligation
Correct answer: Verify hemostasis by observing the ligation site while maintaining exposure
After vessel ligation, the first assistant maintains exposure and observes for bleeding to confirm hemostasis.
Question 6: Which best describes the first assistant's intraoperative communication standard?
- Only speak when directly questioned by the surgeon
- Communicate proactively and clearly using closed-loop technique for critical information (Correct answer)
- Relay all observations through the scrub technician
- Communicate only with the anesthesia provider, not the surgeon
Correct answer: Communicate proactively and clearly using closed-loop technique for critical information
Closed-loop communication with proactive reporting ensures critical information is received and acknowledged, reducing errors.
Question 7: During closure of a fascial layer, the first assistant notices the suture is placed through only half the fascia thickness. What action is appropriate?
- Proceed and reinforce with skin staples later
- Alert the surgeon immediately so the suture can be replaced with a full-thickness bite (Correct answer)
- Add a second suture on top of the inadequate one
- Leave it in place to avoid disrupting the tissue
Correct answer: Alert the surgeon immediately so the suture can be replaced with a full-thickness bite
Partial-thickness fascial bites weaken the closure and increase hernia risk; the surgeon must be alerted to replace it.
CFA First-Assist Surgical Roles 3
During electrosurgery, the first assistant notices the active electrode is near a metal retractor.
What should be done?