CRNFA Certified Registered Nurse First Assistant MCQ 5 — Questions and Answers
Question 1: A patient undergoing a carotid endarterectomy is heparinized intraoperatively. At the end of the procedure, the surgeon elects to reverse anticoagulation. Which agent is administered, and at what ratio to heparin?
- Vitamin K at 1 mg per 100 units of heparin
- Protamine sulfate at 1 mg per 100 units of heparin (Correct answer)
- Fresh frozen plasma at 1 unit per 1,000 units of heparin
- Tranexamic acid at 1 g regardless of heparin dose
Correct answer: Protamine sulfate at 1 mg per 100 units of heparin
Protamine sulfate reverses heparin at a ratio of 1 mg per 100 units of heparin administered, binding and neutralizing heparin activity.
Question 2: The CRNFA is assisting with a laparoscopic Nissen fundoplication. The surgeon asks for more visualization of the gastroesophageal junction. The most appropriate first-assistant action is:
- Increase the CO2 insufflation pressure above 20 mmHg
- Reposition the liver retractor to improve cephalad exposure (Correct answer)
- Request the patient be placed in steep reverse Trendelenburg
- Ask the anesthesiologist to deflate the stomach with an NG tube
Correct answer: Reposition the liver retractor to improve cephalad exposure
Adjusting the liver retractor to elevate the left lobe of the liver is the direct and immediate method to expose the gastroesophageal junction during laparoscopic fundoplication.
Question 3: Which of the following best describes the CRNFA's scope of practice regarding prescribing medications?
- CRNFAs may prescribe any medication within the surgical care episode without restriction
- CRNFAs may prescribe medications only if they hold an additional APRN license with prescriptive authority (Correct answer)
- CRNFAs may verbally order perioperative medications under the surgeon's supervision in all states
- CRNFAs are prohibited from any prescriptive activity under federal law
Correct answer: CRNFAs may prescribe medications only if they hold an additional APRN license with prescriptive authority
Prescriptive authority for CRNFAs requires an additional APRN credential with prescriptive authority, as the CRNFA credential alone does not confer it.
Question 4: During a video-assisted thoracoscopic surgery (VATS) lobectomy, the patient's oxygen saturation suddenly drops and breath sounds disappear on the operative side. The CRNFA should first suspect:
- Tension pneumothorax on the contralateral side
- Endobronchial tube migration causing single-lung ventilation failure (Correct answer)
- Pulmonary artery injury with hemorrhage
- CO2 embolism from thoracoscopic port insufflation
Correct answer: Endobronchial tube migration causing single-lung ventilation failure
Double-lumen endobronchial tube migration can cause loss of lung isolation and ventilation failure, and is a common cause of sudden desaturation in VATS procedures.
Question 5: Which surgical site infection (SSI) prevention measure falls directly within the CRNFA's intraoperative responsibilities?
- Administering preoperative prophylactic antibiotics before incision
- Maintaining normothermia by managing irrigation fluid temperature and exposure time (Correct answer)
- Ordering postoperative wound care protocols
- Performing the preoperative skin antisepsis in the holding area
Correct answer: Maintaining normothermia by managing irrigation fluid temperature and exposure time
The CRNFA controls intraoperative variables including irrigation fluid temperature and limiting tissue exposure, both of which are evidence-based SSI prevention measures.
Question 6: A patient has a documented allergy to iodine. Which preoperative skin antiseptic is the most appropriate substitute for iodine-based preparations?
- Isopropyl alcohol alone (70%)
- Chlorhexidine gluconate (CHG)-based solution (Correct answer)
- Hydrogen peroxide (3%)
- Benzalkonium chloride solution
Correct answer: Chlorhexidine gluconate (CHG)-based solution
Chlorhexidine gluconate is the evidence-based alternative to iodophor-based antiseptics and provides superior residual antimicrobial activity.
Question 7: When the CRNFA applies a running subcuticular (intradermal) suture for skin closure, the primary aesthetic and functional advantage over staples is:
- Faster closure time in long incisions
- Elimination of track marks and improved cosmesis (Correct answer)
- Greater tensile strength resisting wound dehiscence
- Ability to be left permanently without removal
Correct answer: Elimination of track marks and improved cosmesis
Subcuticular sutures avoid skin puncture wounds (track marks) caused by staples or percutaneous sutures, yielding superior cosmetic outcomes.
CRNFA Certified Registered Nurse First Assistant MCQ 5
A patient undergoing a carotid endarterectomy is heparinized intraoperatively.
At the end of the procedure, the surgeon elects to reverse anticoagulation.
Which agent is administered, and at what ratio to heparin?