CRNFA Perioperative Patient Assessment 2 — Questions and Answers
Question 1: Which component of the preoperative assessment is specifically within the CRNFA's scope when functioning as first assistant?
- Ordering and interpreting preoperative labs independently
- Performing a focused preoperative nursing assessment and assisting with history and physical (Correct answer)
- Administering preanesthetic medications independently
- Obtaining informed surgical consent as the primary provider
Correct answer: Performing a focused preoperative nursing assessment and assisting with history and physical
The CRNFA performs a focused preoperative nursing assessment and collaborates with the surgical and anesthesia team — independently ordering labs or obtaining surgical consent is outside CRNFA scope in most states.
Question 2: 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
- Notify the surgeon and anesthesiologist and document the finding (Correct answer)
- Administer iron supplementation per standing order
- 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 3: Which patient history finding should prompt the CRNFA to alert the surgeon about potential difficult airway management?
- Prior appendectomy under general anesthesia without complications
- Short neck, limited cervical extension, and prior difficult intubation (Correct answer)
- Mild seasonal allergies
- Use of an ACE inhibitor for hypertension
Correct answer: Short neck, limited cervical extension, and prior difficult intubation
Anatomical features such as short neck and limited cervical extension, combined with a history of prior difficult intubation, strongly predict difficult airway and must be communicated to the anesthesia team.
Question 4: Which preoperative vital sign finding requires immediate escalation before a patient is brought into the OR?
- Temperature of 38.9°C (102°F) (Correct answer)
- Heart rate of 78 bpm
- Blood pressure of 130/80 mmHg
- Oxygen saturation of 97% on room air
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 5: When reviewing the preoperative checklist, which item related to NPO status is most critical for patient safety?
- Patient consumed a light meal 8 hours ago
- Patient drank 8 oz of clear liquids 4 hours ago per enhanced recovery protocol
- Patient had a full meal 2 hours before surgery (Correct answer)
- Patient has been NPO for 3 hours for solids
Correct answer: Patient had a full meal 2 hours before surgery
A full meal within 2 hours of surgery violates NPO guidelines (8 hours for solids) and places the patient at high risk for aspiration pneumonia under anesthesia.
Question 6: A patient discloses herbal supplement use including garlic, ginger, and Ginkgo biloba. The CRNFA's primary concern is which potential intraoperative complication?
- Hypertensive crisis
- Increased bleeding due to antiplatelet effects of these supplements (Correct answer)
- Malignant hyperthermia
- Renal failure
Correct answer: Increased bleeding due to antiplatelet effects of these supplements
Garlic, ginger, and Ginkgo biloba all have antiplatelet properties that can increase intraoperative and postoperative bleeding risk.
CRNFA Perioperative Patient Assessment 2
Which component of the preoperative assessment is specifically within the CRNFA's scope when functioning as first assistant?