CRNFA Certified Registered Nurse First Assistant MCQ 4 — Questions and Answers
Question 1: When tying a square knot during wound closure, the CRNFA notices the knot is sliding rather than locking. This most likely indicates:
- The suture material is too thick for the tissue
- The throws were made in the same direction, creating a slip knot (Correct answer)
- The suture was moistened before tying
- Excessive tension was applied to the first throw
Correct answer: The throws were made in the same direction, creating a slip knot
A granny (slip) knot results when both throws are in the same direction; a square knot requires alternating throw directions.
Question 2: During a Whipple procedure (pancreaticoduodenectomy), the CRNFA should anticipate the greatest risk of significant hemorrhage during which step?
- Cholecystectomy and common bile duct division
- Dissection and division of the portal vein tributaries (Correct answer)
- Jejunojejunostomy anastomosis
- Gastrojejunostomy reconstruction
Correct answer: Dissection and division of the portal vein tributaries
Dissection around the portal vein and superior mesenteric vessels carries the highest hemorrhage risk due to proximity of high-flow venous structures.
Question 3: Which of the following is a contraindication to the use of absorbable gelatin sponge (Gelfoam) as a topical hemostatic agent?
- Bleeding from a superficial skin laceration
- Use in areas where brain or spinal cord compression could occur (Correct answer)
- Bleeding from a hepatic laceration surface
- Capillary ooze in muscle tissue
Correct answer: Use in areas where brain or spinal cord compression could occur
Gelfoam swells as it absorbs blood and should not be used in closed spaces such as the brain or spinal cord where expansion could cause compression injury.
Question 4: The CRNFA is responsible for maintaining the sterile field. A circulator's gown sleeve briefly contacts the sterile back table. The correct response is:
- Continue the procedure since the contact was brief and unlikely to transfer organisms
- Cover the contaminated area with a sterile drape and continue
- Consider the contaminated items unsterile and remove them from the field (Correct answer)
- Spray the area with alcohol and continue
Correct answer: Consider the contaminated items unsterile and remove them from the field
Any contact between a non-sterile item and the sterile field renders the contaminated items unsterile; they must be removed and replaced.
Question 5: A patient with a known latex allergy is scheduled for surgery. The CRNFA should verify that which item is replaced with a latex-free alternative?
- Stainless steel retractors
- Cautery pencil holster
- Foley catheter and drainage tubing (Correct answer)
- Electrosurgical dispersive electrode cable
Correct answer: Foley catheter and drainage tubing
Foley catheters and drainage tubing traditionally contain latex and must be substituted with latex-free alternatives in sensitized patients.
Question 6: When ligating a vessel with a free tie, the CRNFA should ensure the ligature is placed:
- Exactly at the cut end of the vessel for maximum security
- Proximal to the cut end with enough tissue to prevent slippage (Correct answer)
- Distal to the anticipated division point only
- At the midpoint of the vessel segment to be removed
Correct answer: Proximal to the cut end with enough tissue to prevent slippage
A free tie placed proximal to the cut end with adequate tissue ensures the ligature cannot slip off the vessel stump.
Question 7: Which layer of the abdominal wall provides the greatest strength and is most critical to include in a secure fascial closure?
- Skin and subcutaneous fat
- External and internal oblique muscles
- Transversalis fascia and posterior rectus sheath
- Anterior rectus sheath (external oblique aponeurosis) (Correct answer)
Correct answer: Anterior rectus sheath (external oblique aponeurosis)
The anterior rectus sheath (external oblique aponeurosis) is the strongest layer of the abdominal wall and must be securely closed to prevent hernia formation.
CRNFA Certified Registered Nurse First Assistant MCQ 4
When tying a square knot during wound closure, the CRNFA notices the knot is sliding rather than locking.
This most likely indicates: