CRNFA Certified Registered Nurse First Assistant MCQ 2 — Questions and Answers
Question 1: 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
- Verbally communicate the concern and recommend pausing to identify anatomy (Correct answer)
- Document the concern and proceed without intervention
- Request the anesthesiologist to alter the patient's position
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 2: Which suture material is most appropriate for closing a contaminated abdominal wound where infection risk is high?
- Silk (braided non-absorbable)
- Polyglycolic acid (synthetic absorbable)
- Surgical gut (plain catgut)
- Nylon monofilament (non-absorbable) (Correct answer)
Correct answer: Nylon monofilament (non-absorbable)
Monofilament sutures like nylon harbor fewer bacteria than braided sutures and are preferred in contaminated wounds.
Question 3: A patient undergoing a right hemicolectomy is placed in the supine position with arms extended. Which nerve is most at risk for compression injury in this position?
- Femoral nerve
- Sciatic nerve
- Brachial plexus (Correct answer)
- Common peroneal nerve
Correct answer: Brachial plexus
Arms abducted beyond 90° on arm boards place the brachial plexus at risk for stretch and compression injury.
Question 4: When using monopolar electrosurgery, the CRNFA should ensure the dispersive electrode (grounding pad) is placed:
- Over a bony prominence for secure adherence
- On a well-vascularized muscle mass close to the operative site (Correct answer)
- On the patient's back regardless of surgical site location
- On any dry, hairless skin surface available
Correct answer: On a well-vascularized muscle mass close to the operative site
The dispersive electrode must be placed on a well-vascularized site near the surgical field to ensure adequate current dispersion and reduce burn risk.
Question 5: During fascial closure of a midline laparotomy, the CRNFA uses a running Smead-Jones suture technique. What is the primary advantage of this technique?
- It is faster and uses less suture material than interrupted closure
- It distributes tension across a wide fascial bite to reduce dehiscence risk (Correct answer)
- It avoids the need for retention sutures in obese patients
- It allows for complete wound exploration if infection occurs
Correct answer: It distributes tension across a wide fascial bite to reduce dehiscence risk
The Smead-Jones far-near near-far technique incorporates a wide fascial bite that distributes closure tension and significantly reduces dehiscence rates.
Question 6: 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?
- Protamine sulfate
- Aminocaproic acid (Amicar)
- Fresh frozen plasma (FFP) (Correct answer)
- Tranexamic acid
Correct 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.
Question 7: Which of the following is a recognized role of the CRNFA that distinguishes them from a scrub technician?
- Passing instruments from the sterile field
- Counting sponges and sharps with the circulator
- Providing tissue retraction, hemostasis, and suturing under surgeon direction (Correct answer)
- 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.
CRNFA Certified Registered Nurse First Assistant MCQ 2
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?