CRNFA Certified Registered Nurse First Assistant MCQ 3 — Questions and Answers
Question 1: During a total knee arthroplasty, the surgeon asks the CRNFA to apply a pneumatic tourniquet. The tourniquet pressure for a lower extremity should typically be set at:
- 50 mmHg above systolic blood pressure
- 100 mmHg above systolic blood pressure
- Limb occlusion pressure plus 40–80 mmHg (Correct answer)
- A fixed pressure of 350 mmHg regardless of patient blood pressure
Correct answer: Limb occlusion pressure plus 40–80 mmHg
Tourniquet pressure should be individualized based on limb occlusion pressure plus a safety margin of 40–80 mmHg to minimize tissue and nerve injury.
Question 2: The CRNFA is assisting with a thyroidectomy when the surgeon suspects inadvertent damage to the recurrent laryngeal nerve. Which postoperative finding would confirm unilateral injury?
- Dysphagia and aspiration on swallowing solids
- Hoarseness and weak voice on the ipsilateral side (Correct answer)
- Bilateral stridor requiring emergent reintubation
- Hypocalcemia with positive Chvostek sign
Correct answer: Hoarseness and weak voice on the ipsilateral side
Unilateral recurrent laryngeal nerve injury typically presents with hoarseness due to ipsilateral vocal cord paralysis.
Question 3: When performing blunt dissection in surgery, the CRNFA should use which technique to minimize tissue trauma?
- Rapid sweeping motions parallel to neurovascular structures
- Gentle spreading along anatomical tissue planes using the tips of a hemostat (Correct answer)
- Finger-fracture technique applied perpendicular to the tissue
- Using electrocautery on a low setting as an alternative to sharp dissection
Correct answer: Gentle spreading along anatomical tissue planes using the tips of a hemostat
Gentle spreading along natural tissue planes with hemostatic tips preserves neurovascular structures and reduces collateral tissue damage.
Question 4: In the Trendelenburg position used for pelvic surgery, the CRNFA must monitor for which specific respiratory complication?
- Tension pneumothorax from positive pressure ventilation
- Decreased functional residual capacity and increased risk of atelectasis (Correct answer)
- Pulmonary embolism from venous stasis in the lower extremities
- Carbon dioxide retention from subcutaneous emphysema
Correct answer: Decreased functional residual capacity and increased risk of atelectasis
In Trendelenburg, abdominal contents shift cephalad, reducing functional residual capacity and increasing atelectasis and ventilation challenges.
Question 5: Which type of wound healing is occurring when a surgeon deliberately leaves a contaminated wound open and allows it to close gradually from the base?
- Primary intention
- Secondary intention (Correct answer)
- Tertiary intention (delayed primary closure)
- Quaternary intention
Correct answer: Secondary intention
Secondary intention healing occurs when a wound is left open and closes by granulation tissue formation, wound contraction, and epithelialization.
Question 6: The CRNFA is assisting with an open appendectomy when the appendix is found to be perforated. Which intraoperative action is most important to reduce postoperative infectious complications?
- Immediate wound closure with retention sutures
- Copious irrigation of the peritoneal cavity with warm saline (Correct answer)
- Application of a topical antibiotic-impregnated dressing to the bowel
- Packing the wound with iodoform gauze before fascial closure
Correct answer: Copious irrigation of the peritoneal cavity with warm saline
Copious peritoneal irrigation dilutes bacterial load and reduces the risk of postoperative abscess and peritonitis following perforation.
Question 7: A patient positioned in the lithotomy position for a prolonged perineal procedure is at greatest risk for which compartment syndrome?
- Forearm compartment syndrome from IV infiltration
- Abdominal compartment syndrome from bowel edema
- Lower leg (anterior compartment) syndrome from leg holder pressure (Correct answer)
- Gluteal compartment syndrome from ischemia in the buttocks
Correct answer: Lower leg (anterior compartment) syndrome from leg holder pressure
Prolonged lithotomy position compresses lower leg compartments and reduces perfusion, making anterior compartment syndrome of the lower leg a recognized complication.
CRNFA Certified Registered Nurse First Assistant MCQ 3
During a total knee arthroplasty, the surgeon asks the CRNFA to apply a pneumatic tourniquet.
The tourniquet pressure for a lower extremity should typically be set at: