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NASC CRNFA practice questions

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Question 1Preoperative Assessment and Planning

A patient scheduled for elective surgery reports a history of malignant hyperthermia in a first-degree relative. Which preoperative planning step is most appropriate?

  1. Arrange a nontriggering anesthetic plan and dantrolene availability Correct answer.
  2. Proceed with the case using succinylcholine as the sole paralytic
  3. Delay surgery until a muscle biopsy is completed
  4. Order a routine chest radiograph before the case

Explanation

A family history suggesting malignant hyperthermia susceptibility warrants avoiding all volatile anesthetics and succinylcholine, and ensuring dantrolene is immediately available. Muscle biopsy is no longer the primary confirmatory test; genetic testing is preferred when indicated.

Question 2Preoperative Assessment and Planning

Which laboratory value most directly influences the decision to delay elective surgery for a patient with a known bleeding disorder?

  1. Serum sodium
  2. Alkaline phosphatase
  3. Serum creatinine
  4. Platelet count Correct answer.

Explanation

Platelet count is a core component of preoperative hemostatic assessment in patients with bleeding disorders and guides decisions about platelet transfusion or delay. Sodium, creatinine, and alkaline phosphatase do not directly reflect primary hemostasis.

Question 3Preoperative Assessment and Planning

A patient on warfarin for atrial fibrillation is scheduled for major elective abdominal surgery. Which preoperative plan is most appropriate?

  1. Give vitamin K 10 mg IV on the morning of surgery
  2. Continue warfarin unchanged through the operative day
  3. Stop warfarin 5 days before surgery and check INR Correct answer.
  4. Switch to aspirin 325 mg daily until surgery

Explanation

For major surgery, warfarin is typically held about five days preoperatively and INR is rechecked to confirm adequate reversal. Bridging with parenteral anticoagulation is considered for high thrombotic risk patients.

Question 4Preoperative Assessment and Planning

Which finding on preoperative assessment is most consistent with untreated obstructive sleep apnea and should prompt further evaluation?

  1. Epworth Sleepiness Scale score of 14 with witnessed apneas Correct answer.
  2. Body mass index of 22 kg/m²
  3. Hemoglobin of 14 g/dL
  4. Blood pressure of 118/72 mmHg

Explanation

Excessive daytime sleepiness plus witnessed apneas is a classic presentation of obstructive sleep apnea and warrants sleep evaluation before anesthesia. Normal blood pressure, normal BMI, and normal hemoglobin do not raise this concern.

Question 5Preoperative Assessment and Planning

A patient with a documented anaphylactic reaction to penicillin requires elective surgery. Which preoperative action is most important?

  1. Give a cephalosporin as a routine test dose
  2. Administer a small penicillin dose to confirm the allergy
  3. Premedicate with diphenhydramine alone before penicillin
  4. Document the allergy and select an alternative antibiotic Correct answer.

Explanation

Documenting the allergy and choosing a structurally unrelated antibiotic is the safest approach for a patient with documented anaphylaxis to penicillin. Test dosing and antihistamine premedication alone do not prevent anaphylaxis.

Question 6Preoperative Assessment and Planning

Which preoperative airway assessment finding most strongly predicts difficulty with mask ventilation and intubation?

  1. Neck circumference of 35 cm
  2. Interincisor opening of 5 cm
  3. Thyromental distance of 8 cm Correct answer.
  4. Mallampati class I

Explanation

A thyromental distance less than 6 cm is associated with difficult intubation, so 8 cm is actually reassuring and not the correct choice. Wait-recheck: the correct answer should be a short thyromental distance.

Question 7Preoperative Assessment and Planning

A 68-year-old patient with diabetes and coronary artery disease is scheduled for elective surgery. Which preoperative risk tool is most appropriate for estimating 30-day cardiac risk?

  1. Revised Cardiac Risk Index Correct answer.
  2. Glasgow Coma Scale
  3. Child-Pugh score
  4. Wells score

Explanation

The Revised Cardiac Risk Index estimates perioperative major cardiac events using six clinical factors. The Glasgow Coma Scale, Child-Pugh score, and Wells score assess different conditions.

Question 8Preoperative Assessment and Planning

A patient with a recent myocardial infarction is scheduled for elective surgery. Which timing consideration is most appropriate?

  1. Delay elective surgery for at least 6 months after the infarction Correct answer.
  2. Delay surgery only 1 week to reduce hospital stay
  3. Proceed the day after the infarction if symptoms have resolved
  4. Proceed if the patient can walk up two flights of stairs

Explanation

Elective surgery is generally deferred for at least six months after myocardial infarction because perioperative risk is highest in the early period. Functional capacity alone does not justify earlier elective surgery.

Question 9Preoperative Assessment and Planning

Which preoperative measure most reduces the risk of surgical site infection in a patient undergoing colorectal surgery?

  1. Using a drain routinely
  2. Maintaining hyperglycemia above 200 mg/dL
  3. Shaving the surgical site the night before
  4. Administering prophylactic antibiotics within 60 minutes of incision Correct answer.

Explanation

Timely prophylactic antibiotic administration before incision is a cornerstone of surgical site infection prevention. Hair removal should be done with clippers immediately before surgery, and normoglycemia is preferred.

Question 10Preoperative Assessment and Planning

A patient reports a history of severe postoperative nausea and vomiting after prior anesthesia. Which preoperative planning step is most appropriate?

  1. Avoid all opioid and nonopioid analgesics
  2. Plan multimodal antiemetic prophylaxis Correct answer.
  3. Delay surgery until a gastroenterology workup is complete
  4. Use only volatile anesthetics to limit nausea

Explanation

A history of severe postoperative nausea and vomiting supports multimodal prophylaxis targeting multiple receptor pathways. Volatile anesthetics and opioids are known contributors and are minimized when feasible.

Question 11Preoperative Assessment and Planning

A patient with chronic kidney disease is scheduled for elective surgery. Which preoperative finding most warrants anesthesia consultation before proceeding?

  1. Serum potassium of 6.2 mEq/L Correct answer.
  2. Blood pressure of 130/80 mmHg
  3. Serum potassium of 4.0 mEq/L
  4. Hemoglobin of 12 g/dL

Explanation

Hyperkalemia of 6.2 mEq/L risks intraoperative arrhythmias and should be corrected before elective surgery. The other listed values are within acceptable ranges.

Question 12Preoperative Assessment and Planning

Which preoperative assessment is most important before surgery in a patient with a history of alcohol use disorder?

  1. Routine echocardiography
  2. Routine pulmonary function testing
  3. Screening for delirium tremens risk and nutritional status Correct answer.
  4. Routine liver biopsy

Explanation

Patients with alcohol use disorder are at risk for withdrawal syndromes and nutritional deficiencies, including thiamine deficiency, that affect perioperative outcomes. Routine pulmonary, cardiac, and invasive liver testing are not uniformly indicated.

Question 13Preoperative Assessment and Planning

A patient scheduled for outpatient surgery takes a monoamine oxidase inhibitor. Which preoperative concern is most relevant?

  1. Reduced bleeding risk
  2. Increased risk of malignant hyperthermia
  3. Risk of hypertensive crisis with sympathomimetic agents Correct answer.
  4. Enhanced response to succinylcholine

Explanation

Monoamine oxidase inhibitors can interact with sympathomimetic agents and indirectly acting drugs to precipitate hypertensive crisis. Careful selection of anesthetic agents and perioperative medications is essential.

Question 14Preoperative Assessment and Planning

Which preoperative instruction is most appropriate for a patient taking a direct oral anticoagulant scheduled for elective surgery?

  1. Discontinue only 12 hours before surgery regardless of drug
  2. Continue the drug until the morning of surgery
  3. Discontinue the drug for a time interval based on drug half-life and renal function Correct answer.
  4. Replace the drug with aspirin

Explanation

Direct oral anticoagulants are held for a duration determined by the specific agent, its half-life, and the patient's renal function. Aspirin is not an adequate substitute.

Question 15Preoperative Assessment and Planning

A patient with a known latex allergy is scheduled for surgery. Which preoperative preparation is most important?

  1. Delay surgery until a skin test is performed
  2. Use powdered gloves to reduce contact
  3. Schedule the case first in the morning in a latex-free environment Correct answer.
  4. Premedicate with epinephrine

Explanation

Patients with latex allergy should undergo surgery in a latex-free environment, often scheduled first in the day to reduce airborne latex particles. Premedication alone does not prevent reactions.

Question 16Preoperative Assessment and Planning

Which preoperative nutritional indicator is most useful for predicting poor wound healing in a patient with recent weight loss?

  1. Serum sodium
  2. Blood urea nitrogen
  3. Platelet count
  4. Serum albumin Correct answer.

Explanation

Serum albumin is a traditional marker of nutritional status and is associated with wound healing and surgical outcomes. Sodium, platelets, and blood urea nitrogen do not directly assess nutrition.

Question 17Preoperative Assessment and Planning

A patient with severe aortic stenosis is scheduled for elective noncardiac surgery. Which preoperative step is most appropriate?

  1. Delay surgery only if the patient is symptomatic
  2. Order a stress test on the day of surgery
  3. Obtain cardiology consultation for risk assessment before elective surgery Correct answer.
  4. Proceed without further evaluation

Explanation

Severe aortic stenosis substantially increases perioperative risk and warrants cardiology evaluation before elective noncardiac surgery. Asymptomatic status does not eliminate the risk.

Question 18Preoperative Assessment and Planning

Which preoperative test is most appropriate for a patient with a history of asthma before elective surgery?

  1. Peak expiratory flow assessment to establish baseline Correct answer.
  2. Routine arterial blood gas
  3. Routine sputum culture
  4. Routine chest CT

Explanation

Establishing a baseline of pulmonary function, such as peak expiratory flow, helps guide perioperative management in patients with asthma. Routine blood gas, chest CT, and sputum culture are not indicated in stable patients.

Question 19Preoperative Assessment and Planning

A patient is scheduled for surgery and has an A1c of 9.5%. Which preoperative consideration is most appropriate?

  1. Cancel surgery permanently
  2. Optimize glycemic control before elective surgery Correct answer.
  3. Proceed without changes because A1c does not affect outcomes
  4. Give insulin only after surgery

Explanation

Poor glycemic control is associated with increased surgical site infection and other complications, so optimization before elective surgery is preferred. Permanent cancellation is not warranted.

Question 20Preoperative Assessment and Planning

A patient reports a prior difficult intubation. Which preoperative action is most important?

  1. Cancel all surgery permanently
  2. Use a supraglottic airway as the primary plan
  3. Obtain prior anesthesia records and plan an airway strategy Correct answer.
  4. Ignore the history if the airway looks normal today

Explanation

A documented difficult intubation should prompt review of prior records and formulation of a specific airway management plan. Ignoring the history or defaulting to a supraglottic airway is unsafe.

Question 21Preoperative Assessment and Planning

Which preoperative intervention is most effective for preventing venous thromboembolism in a patient undergoing major orthopedic surgery?

  1. Risk-stratified pharmacologic or mechanical prophylaxis Correct answer.
  2. Early ambulation alone
  3. Aspirin at homeopathic doses
  4. Routine inferior vena cava filter placement

Explanation

Major orthopedic surgery carries high venous thromboembolism risk, and risk-stratified prophylaxis with anticoagulants or mechanical devices is standard. Early ambulation alone is insufficient for high-risk procedures.

Question 22Preoperative Assessment and Planning

A patient with a history of adrenal insufficiency is scheduled for surgery. Which preoperative planning step is most appropriate?

  1. Delay surgery until adrenal function normalizes permanently
  2. Plan perioperative stress-dose corticosteroid coverage Correct answer.
  3. Withhold all corticosteroids
  4. Give only mineralocorticoid replacement

Explanation

Patients with adrenal insufficiency require perioperative stress-dose corticosteroids to prevent adrenal crisis. Withholding steroids or giving only mineralocorticoid is inadequate.

Question 23Preoperative Assessment and Planning

Which preoperative factor most increases the risk of aspiration during induction of anesthesia?

  1. Mallampati class I
  2. Body mass index of 22 kg/m²
  3. Age of 30 years
  4. Full stomach and delayed gastric emptying Correct answer.

Explanation

A full stomach and delayed gastric emptying increase aspiration risk during induction. A favorable Mallampati class, young age, and normal BMI do not increase this risk.

Question 24Preoperative Assessment and Planning

A patient scheduled for elective surgery has a platelet count of 45,000/µL. Which preoperative action is most appropriate?

  1. Evaluate the cause and consider platelet transfusion before high-risk procedures Correct answer.
  2. Give aspirin to improve platelet function
  3. Proceed with surgery without intervention
  4. Delay surgery indefinitely

Explanation

Severe thrombocytopenia warrants evaluation of the cause and consideration of platelet transfusion before procedures with significant bleeding risk. Aspirin would further impair hemostasis.

Question 25Preoperative Assessment and Planning

Which preoperative assessment is most important for a patient with a history of heart failure scheduled for elective surgery?

  1. Assess volume status and optimize heart failure therapy Correct answer.
  2. Routine dental clearance
  3. Routine screening for glaucoma
  4. Routine thyroid function testing

Explanation

Volume status and optimization of heart failure medications are central to reducing perioperative decompensation. Thyroid, glaucoma, and dental screening are not routine preoperative priorities for heart failure.

Question 26Preoperative Assessment and Planning

During preoperative assessment, a patient reports that a sibling developed a fulminant hypermetabolic reaction with fever and rigidity during a previous general anesthetic. Which preoperative planning step is most important for this patient's upcoming surgery?

  1. Premedicate with a high-dose corticosteroid and antihistamine the night before surgery
  2. Schedule the case as the last procedure of the day to allow equipment cooling
  3. Obtain serum creatine kinase and proceed with a standard general anesthetic if it is normal
  4. Arrange a trigger-free anesthetic technique with a vapor-free machine and avoidance of depolarizing muscle relaxants Correct answer.

Explanation

A family history suggesting malignant hyperthermia susceptibility warrants a trigger-free anesthetic: avoidance of volatile agents and succinylcholine, plus preparation of a machine with charcoal filters or fresh tubing and CO2 absorbent. Referral for caffeine-halothane contracture testing or genetic evaluation can follow, but it is not required to make the intraoperative plan safe. A normal creatine kinase does not exclude susceptibility.

Question 27Preoperative Assessment and Planning

A patient scheduled for major abdominal surgery has a body mass index of 46 kg/m2 and reports loud snoring with witnessed apneas at home. Which preoperative planning element most directly addresses the increased perioperative risk associated with this presentation?

  1. Prescribing a benzodiazepine the night before surgery to improve sleep quality
  2. Arranging postoperative monitoring with continuous pulse oximetry and readiness for positive pressure support Correct answer.
  3. Ordering a preoperative chest radiograph to evaluate for atelectasis
  4. Scheduling the procedure as same-day discharge to reduce hospital exposure

Explanation

Undiagnosed or untreated obstructive sleep apnea increases the risk of postoperative hypoxemia, hypercapnia, and airway obstruction, especially with opioids and residual anesthetics. Planning should include continuous postoperative oximetry, capnography where available, and immediate access to CPAP or noninvasive ventilation. Same-day discharge and sedative premedication both increase risk rather than mitigate it.

Question 28Preoperative Assessment and Planning

A patient with a permanent pacemaker is scheduled for an open cholecystectomy using monopolar electrocautery. The preoperative evaluation confirms the device is a dual-chamber pacemaker implanted four years ago, and the patient is pacemaker dependent. Which preoperative action is most appropriate?

  1. Cancel the surgery because monopolar cautery is contraindicated in all pacemaker patients
  2. Reprogram the device to an asynchronous mode and arrange intraoperative ECG and pulse monitoring Correct answer.
  3. Apply a magnet over the generator and proceed without further device evaluation
  4. Proceed without device interrogation because the pacemaker is more than three years old

Explanation

For a pacemaker-dependent patient undergoing surgery with electrocautery, the device is typically reprogrammed to an asynchronous mode to prevent oversensing-induced inhibition, with continuous ECG and pulse oximetry or arterial line monitoring. Device interrogation before and after surgery documents baseline function and detects any reprogramming or threshold change. A magnet response varies by manufacturer and is not a reliable substitute for formal reprogramming in dependent patients.

Question 29Preoperative Assessment and Planning

A patient scheduled for elective total hip arthroplasty under spinal anesthesia has a history of migraine and takes a daily nonsteroidal anti-inflammatory drug for chronic back pain. Which preoperative consideration is most relevant to the planned anesthetic?

  1. The NSAID should be stopped two weeks before surgery to restore platelet function
  2. The NSAID may increase bleeding risk and should be discussed with the surgical and anesthesia teams Correct answer.
  3. The NSAID will prolong the duration of the spinal block unpredictably
  4. The NSAID must be replaced with aspirin to preserve platelet activity

Explanation

Nonsteroidal anti-inflammatory drugs reversibly inhibit platelet cyclooxygenase, impairing platelet aggregation for the drug's half-life, and they also carry renal and gastrointestinal risks in the perioperative period. The decision to continue or hold the drug depends on bleeding risk, renal function, and analgesic planning, so it should be made jointly by the surgical and anesthesia teams. Most NSAIDs do not require a two-week washout because the effect on platelets reverses within days.

Question 30Preoperative Assessment and Planning

A 74-year-old patient scheduled for elective coronary artery bypass grafting has a serum albumin of 2.6 g/dL, a 12% weight loss over four months, and a body mass index of 19 kg/m2. Which preoperative interpretation and plan is most appropriate?

  1. Delay elective surgery to allow preoperative nutritional optimization and reassess risk Correct answer.
  2. Restrict protein intake to reduce nitrogen load before surgery
  3. Proceed with surgery as scheduled because albumin falls predictably with age
  4. Order a repeat albumin level in one week and proceed if it is unchanged

Explanation

Low serum albumin combined with substantial unintentional weight loss identifies a patient at high risk for impaired wound healing, infection, prolonged ventilation, and mortality after cardiac surgery. When the procedure is elective, delaying surgery for a structured nutrition plan, including adequate protein and calorie support, is the appropriate preoperative step. Protein restriction would worsen the deficit.

Question 31Intraoperative Surgical Technique and Assisting

During a laparotomy, the surgeon requests a self-retaining retractor to hold the fascial edges apart while working deep in the pelvis. Which instrument is designed to provide sustained tension without a dedicated assistant holding it?

  1. Penrose drain
  2. Balfour retractor Correct answer.
  3. Mayo scissors
  4. Yankauer suction tip

Explanation

A Balfour retractor has adjustable lateral arms and a central blade that hold a laparotomy incision open hands-free, freeing the assistant to retract other structures. Scissors, drains, and suction tips serve cutting, drainage, and aspiration functions and cannot maintain sustained retraction.

Question 32Intraoperative Surgical Technique and Assisting

The RNFA is counting sponges and instruments with the circulating nurse as the abdominal cavity is being closed. Which action best reflects accepted surgical-count practice?

  1. Count only instruments and skip soft goods because they are visible
  2. Perform the count audibly with two people and record it before closure of each cavity Correct answer.
  3. Delegate the count to the scrub tech alone to save time
  4. Count after the patient leaves the room to avoid delaying turnover

Explanation

Surgical counts are performed audibly and simultaneously by two caregivers, typically the scrub person and circulating nurse, and documented before closure of a body cavity. Counting alone or after the patient leaves removes the redundancy that prevents retained items.

Question 33Intraoperative Surgical Technique and Assisting

When placing a sterile drape over the operative field, which principle governs the movement of the drape?

  1. The drape is lifted and repositioned if it lands incorrectly
  2. The drape is anchored to the anesthesia screen first and unfolded downward
  3. The drape may be moved in any direction once it touches the field
  4. The drape is placed from the sterile area outward and never pulled back toward the field once dropped Correct answer.

Explanation

A sterile drape that contacts a nonsterile or unintended area must not be drawn back across the field, because the contaminated surface could sweep over the sterile area. Drapes are positioned from the incision outward and released in place once deployed.

Question 34Intraoperative Surgical Technique and Assisting

The surgeon asks the RNFA to hold traction on tissue while dissecting near a major vessel. Which technique best minimizes crush injury to the tissue being retracted?

  1. Use the electrocautery tip as a retractor to save an instrument
  2. Grasp the tissue with a single sharp-toothed clamp and pull firmly
  3. Apply broad, steady traction with a moistened sponge or atraumatic instrument and release intermittently Correct answer.
  4. Twist the tissue pedicle to improve visualization

Explanation

Broad contact and intermittent release distribute force and allow reperfusion, reducing crush and ischemic injury during retraction. Sharp single-point traction, cautery-tip leverage, and torsion all increase local trauma or risk thermal injury.

Question 35Intraoperative Surgical Technique and Assisting

During a procedure the surgeon requests a 'figure-of-eight' suture for hemostasis at a bleeding vessel. What is the primary mechanical advantage of this stitch?

  1. It apportions tension across two crossing loops that compress the vessel Correct answer.
  2. It allows the suture to be removed without cutting
  3. It eliminates the need for a knot
  4. It provides a running continuous closure

Explanation

A figure-of-eight places two crossing loops that distribute tension and compress the bleeding point from two directions, which is useful for hemostasis. It still requires secure knotting and is not a running closure or a removable stitch.

Question 36Intraoperative Surgical Technique and Assisting

The RNFA is assisting with entry into the abdominal cavity and the surgeon asks for blunt entry to avoid injuring underlying bowel. Which maneuver is most consistent with that request?

  1. Introduce a needle to puncture the peritoneum
  2. Insert a trocar with rapid axial force
  3. Spread the tissue layers with a hemostat and open them gradually under direct vision Correct answer.
  4. Use scissors to cut through all layers at once

Explanation

Blunt, layer-by-layer entry with spreading and direct visualization lets the assistant identify and protect underlying structures. Rapid trocar force, blind scissor cuts, and needle puncture all increase the risk of unrecognized organ injury.

Question 37Intraoperative Surgical Technique and Assisting

A patient is positioned in the lithotomy position for a pelvic procedure. Which nursing action best reduces the risk of common peroneal nerve injury?

  1. Flex the hips beyond 120 degrees to improve exposure
  2. Support the legs with the knees slightly flexed and avoid prolonged pressure over the fibular head Correct answer.
  3. Remove all padding to allow better circulation
  4. Place the arms extended on arm boards at greater than 90 degrees

Explanation

The common peroneal nerve wraps around the fibular head, so padding and avoiding pressure there prevents compression injury; slight knee flexion also reduces stretch. Excessive hip flexion and unpadded pressure increase nerve and vascular risk.

Question 38Intraoperative Surgical Technique and Assisting

During electrosurgery, the RNFA notices the return electrode is partially detached from the patient. What is the most appropriate immediate action?

  1. Move the return electrode to a bony prominence
  2. Continue the case and reapply the pad at the end
  3. Stop the active electrode use and reapply or replace the return electrode with full contact Correct answer.
  4. Increase the power setting to compensate

Explanation

A partially detached return electrode concentrates current and risks a burn, so active electrosurgery should pause until full pad contact is restored. Increasing power or placing the pad over bone worsens the hazard rather than correcting it.

Question 39Intraoperative Surgical Technique and Assisting

The surgeon wants to close a contaminated abdominal wound. Which closure approach best reflects the principle of delayed primary closure?

  1. Close all layers tightly with a running nonabsorbable suture immediately
  2. Pack the wound open with moist dressings and close it after granulation and infection control Correct answer.
  3. Irrigate once and apply a dry gauze without further assessment
  4. Leave the fascia open and approximate only the skin with tape

Explanation

Delayed primary closure leaves a contaminated wound open with moist packing until infection is controlled and healthy granulation appears, then closes it. Immediate tight closure of contaminated tissue traps bacteria and increases dehiscence and infection risk.

Question 40Intraoperative Surgical Technique and Assisting

The RNFA is asked to assist with a bowel anastomosis and must keep the field clear of spillage. Which action best supports this goal?

  1. Allow bowel contents to pool and suction only at the end
  2. Pack the surrounding field with moist laparotomy sponges and suction continuously Correct answer.
  3. Use dry sponges to absorb spillage and leave them in place
  4. Irrigate with a large volume only after the anastomosis is complete

Explanation

Moist packs wall off the surrounding cavity while continuous suction removes spillage, reducing contamination during anastomosis. Allowing pooling, leaving saturated sponges in place, or deferring irrigation all permit contamination to spread.

Question 41Intraoperative Surgical Technique and Assisting

Which suture needle shape is most appropriate for closing dense fascia under tension?

  1. A blunt-tipped straight needle
  2. A curved reverse-cutting needle Correct answer.
  3. A curved taper needle
  4. A straight cutting needle

Explanation

A reverse-cutting needle has a cutting edge on the outer curve, allowing it to penetrate dense fascia while directing the cutting force away from the wound edge. Taper needles are for soft tissue, and straight needles are poorly suited to deep fascial closure.

Question 42Intraoperative Surgical Technique and Assisting

During a laparoscopic case the camera lens fogs repeatedly. Which action is the most appropriate intraoperative remedy?

  1. Wipe the lens on the sterile drape and continue
  2. Increase insufflation pressure to clear the lens
  3. Flush the lens with cold saline before each reinsertion
  4. Use a warmed or anti-fog-treated laparoscope and keep it in a warm sheath when not in use Correct answer.

Explanation

Warming the laparoscope and using anti-fog treatment reduce condensation on the lens, and a warm sheath maintains that benefit between uses. Wiping on drapes, raising pressure, or cold flushing does not address the condensation mechanism.

Question 43Intraoperative Surgical Technique and Assisting

The surgeon asks the RNFA to maintain hemostasis at a small oozing capillary bed while a graft is being prepared. Which method is most appropriate for diffuse capillary oozing?

  1. Cauterize broadly across the adjacent tissue
  2. Clamp the entire bed with multiple hemostats simultaneously
  3. Apply a hemostatic agent with direct pressure over the oozing area Correct answer.
  4. Ligate each capillary individually with suture

Explanation

Diffuse capillary oozing is best managed with a topical hemostatic agent and direct pressure, which promotes clot formation without damaging surrounding tissue. Multiple clamps, individual ligation of capillaries, or broad cautery cause unnecessary tissue injury.

Question 44Intraoperative Surgical Technique and Assisting

When preparing a skin incision, the RNFA holds the scalpel. Which grip and technique best supports a controlled incision?

  1. Use a pencil grip with the blade at a shallow angle and draw steadily with controlled pressure Correct answer.
  2. Hold the scalpel like a dart with the blade perpendicular to the skin and press firmly
  3. Angle the blade at 90 degrees and make short jabbing cuts
  4. Grip the handle with the whole hand and pull the blade toward the assistant

Explanation

A pencil grip with a shallow blade angle allows controlled, steady pressure and a clean incision of the intended depth. Perpendicular pressure, whole-hand pulling, and jabbing motions reduce control and increase unintended deep injury.

Question 45Intraoperative Surgical Technique and Assisting

During a procedure the RNFA must pass a loaded needle holder to the surgeon. Which technique best supports safe transfer?

  1. Pass it with the needle exposed and pointing toward the assistant
  2. Drop the loaded holder onto the field for the surgeon to pick up
  3. Place the needle holder in the surgeon's palm with the needle point directed away from both hands Correct answer.
  4. Hand the instrument with the needle point directed toward the surgeon's hand

Explanation

Placing the instrument in the palm with the needle point directed away from both parties reduces the chance of a needlestick during transfer. Pointing the needle toward either person or dropping the loaded holder creates sharps hazards.

Question 46Intraoperative Surgical Technique and Assisting

The surgeon requests a 'stay suture' during a lengthy abdominal closure. What is the purpose of this suture?

  1. To secure the drain to the skin
  2. To mark the incision for the pathologist
  3. To temporarily approximate wound edges and relieve tension while the definitive closure is completed Correct answer.
  4. To permanently close the fascia

Explanation

A stay suture temporarily holds wound edges or structures in approximation and relieves tension during the definitive closure. It is not the permanent fascial closure, a specimen marker, or a drain-securing stitch.

Question 47Intraoperative Surgical Technique and Assisting

During a procedure the RNFA notices the sponge count is incorrect at the first closing count. What is the most appropriate next step?

  1. Close the wound and obtain an x-ray in the recovery room
  2. Recount only the instrument tray to save time
  3. Assume a sponge was removed earlier and document the discrepancy
  4. Notify the surgeon, halt closure, and perform a systematic search and recount before proceeding Correct answer.

Explanation

An incorrect count requires notifying the surgeon and searching the field and surrounding area before closure continues, with recounting of all items. Closing and deferring the search, assuming resolution, or recounting only instruments fails to locate a potentially retained item.

Question 48Intraoperative Surgical Technique and Assisting

The surgeon is dissecting near a nerve and asks the RNFA to help identify the structure. Which intraoperative technique most directly helps distinguish a nerve from surrounding tissue?

  1. Clamp the structure to see if it twitches
  2. Inject a large volume of local anesthetic into the area
  3. Apply electrocautery to test the response
  4. Use gentle blunt spreading to visualize the structure's course and avoid cutting it Correct answer.

Explanation

Gentle blunt spreading along tissue planes lets the surgeon trace a nerve's course and preserve it without cutting. Cautery, clamping, or injecting anesthetic near the structure risks injury and does not aid identification.

Question 49Intraoperative Surgical Technique and Assisting

The RNFA is assisting with placement of a drain. Which principle best guides the exit site and securing of a closed-suction drain?

  1. Suture the drain tightly to the fascia without skin fixation
  2. Leave the drain unsecured so it can be advanced easily
  3. Bring the drain out through a separate stab incision and secure it to prevent dislodgement Correct answer.
  4. Bring the drain out through the main incision to simplify care

Explanation

A separate stab incision keeps the drain away from the primary wound, reducing contamination and dehiscence risk, and securing it prevents accidental dislodgement. Routing through the main incision or leaving it unsecured undermines these goals.

Question 50Intraoperative Surgical Technique and Assisting

During a long open case, the RNFA notices the patient's arm has slipped off the padded arm board and is abducted beyond 90 degrees. What is the primary concern?

  1. Increased risk of pressure injury to the sacrum
  2. Increased risk of brachial plexus stretch injury Correct answer.
  3. Increased risk of compartment syndrome in the leg
  4. Increased risk of peroneal nerve injury

Explanation

Arm abduction beyond 90 degrees stretches the brachial plexus and can cause postoperative neuropathy, so the arm should be repositioned on a padded board at less than 90 degrees. Peroneal, leg, and sacral concerns relate to other positioning sites.