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RNFA Final Exam Prep 2025 | Actual Exam
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Precautions apply to blood, all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood, mucous membranes, and non-intact skin. - ✔✔Standard Which of the following anesthetics may result in fasiculations for the patient? - ✔✔Succhinylcholine Hypothermia has been shown to be a factor that may place the surgical patient at risk for infection and delayed healing. What intervention is an engineered control factor to protect the patient from hypothermia? - ✔✔b. set the ambient room temperature between 68 ° and 73 ° F A basic anesthesia monitoring device that is used during general anesthesia to confirm successful endotracheal tube placement and determine the presence of gas exchange is the: - ✔✔capnometer/end-tidal CO2 monitor The first step in the decontamination process is: - ✔✔Cleaning Which of the following requires at minimum, 2 patient identifiers on specimen labels? - ✔✔Joint Commission A 9 - year-old diabetic with an insulin pump, has arrived in the OR for emergency repair of superficial facial and deep arm lacerations. The RNFA should consider which of the following options for energy- generated hemostasis? - ✔✔Bipolar Electrosurgery Unit During a hysteroscopy, sterile saline is used to expand the intrauterine compartment and enhance visualization. The perioperative nurse is concerned that approximately 500 ml of fluid was unaccounted for and alerted the surgeon and RNFA. The nurse's motive for this surveillance is to: - ✔✔Potential for Intervastation
Which of the following statements reflects the location of the arcuate line? - ✔✔one third of the distance between the umbilicus and the symphysis pubis. Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained surgical items (RSI). What risk reduction strategy could prevent RSI? - ✔✔Replacing or tagging sponges and laparotomy instruments with RFID chips. The surgical hand scrub is designed to render the hands, nails, and arms - ✔✔Surgically Clean The RNFA instructed the new anesthesia resident in the proper positioning of the arm and hands on the OR bed armboards. The resident was cautioned to avoid pressure on the elbow to prevent: - ✔✔Ulnar Nerve Injury A type of suture to help eliminate tension on the primary suture line is known as: - ✔✔Retention Suture Identify the primary substance found in the epidermis that protects the body from fluid loss and invasion by pathogens. - ✔✔Keratin When a patient absorbs an unsafe amount of local anesthetic into the bloodstream, a catastrophic outcome is possible. Treatment for LAST includes the use of which of the following? - ✔✔Lipids When buried in tissue, silk loses its tensile strength after what period of time? - ✔✔ 1 Year Guidelines from WHO focus on which of the following in the prevention of surgical site infections? - ✔✔Use of Prophylactic Antibiotics To help visualize abdominal structures and to enhance safety during laparoscopic procedures, a pneumoperitoneum is created. After Veress needle confirmation, insufflation tubing is connected and the process begun. CO 2 gas is used to insufflate the abdominal cavity at an ideal flow rate of to achieve an ideal intra-abdominal pressure of _. - ✔✔ 9 L/min; 14 to 16 mm Hg
Laryngospasm is a serious complication often seen in the PACU setting. What is the ideal immediate and last resort response by the anesthesia provider or perianesthesia nurse in an emerging patient who has been in spasm for over 1 minute? - ✔✔suctioning, IV succinylcholine administration, and reintubation Which of the following is not a characteristic of silk suture? - ✔✔Memory The first case of the day is scheduled as a knee arthroscopy for an otherwise healthy 24 year old patient. Upon pre assessment, the patient admits to a family history of anesthesia and surgical complications. Patient also states last oral intake consisted of eating a cheese steak and drinking 2 cans of beer the night before at 11 : 30 PM. The patient subsequently vomited when intubation was performed and experienced respiratory distress upon extubation. What measure could have been taken by the team to prevent aspiration based on the patient's history? - ✔✔The perioperative nurse applying cricoid pressure during induction through intubation The instillation of a local anesthetic into the subarachnoid space is termed: - ✔✔Spinal Anesthesia What is the appropriate action if the doctor is delayed after the room and instruments have been opened? - ✔✔Cover the instruments with a sterile drape and have the scrub nurse continually visually observe the room for breaches in sterility. Select the positioning device commonly used for positioning the head during procedures such as craniotomies. - ✔✔Mayfield Head Positioners Hypotension is a blood pressure reading that is 20 % less than the patient's normal baseline pressure. Hypovolemia is the most common cause of postoperative hypotension; however, hypotension may also be caused by cardiac dysfunctions. Which of the following cardiac conditions will present with hypotension? - ✔✔myocardial infarction, myocardial tamponade, and pulmonary embolism The ideal suture material is one that has handling characteristics such as: - ✔✔Pliability Which of the following patient modifiable factors can contribute to surgical site infections? - ✔✔Alcoholism
Which anesthetic agent could not be given if an IV-only anesthesia plan was employed? - ✔✔Desflurane A type of monofilament suture that does not require the user to tie knots is known as: - ✔✔Barbed Which statement about surgical dressings is true? - ✔✔Surgical dressings cushion and protect the wound from trauma and gross contamination, and absorb drainage. A common dysrythmia seen after surgery is: - ✔✔Sinus Tachycardia The type of wound closure that occurs when approximation of the wound edges does not occur for 3 or more days after a surgical procedure. - ✔✔Third Intention Your patient was presented with the prepared informed consent form during the discussion with her surgeon concerning her scheduled surgery. Before signing the consent form, the patient informed the surgeon that they did not want any medical students or surgical residents performing any parts of the procedure other than assisting and did not want any photographs taken. The surgeon agreed and crossed out those portions of the form. The patient initialed them prior to signing the consent. Your patient was exercising which patient right? - ✔✔Right to Informed Consent A reverse cutting needle is preferred for suturing. - ✔✔Cutaneous Linda Gardner is highly allergic to latex and the anesthesia provider plans to give Linda prophylactic medications before anesthesia. What medications might be administered to Linda in the preoperative holding area? - ✔✔Prednisone and a beta-agonist inhaler Surgical consents should be written at what level to meet health literacy needs of all patients? - ✔✔ 5 th Grade The tensile strength of lactic & glycolic acid polymers is sufficient for approximation of tissues for weeks. - ✔✔ 2 - 3
When assisting with a trauma patient in the surgical setting, it is important for the RNFA to be aware of the "vicious triad" that can increase the risk for mortality. The triad includes: - ✔✔Metabolic acidosis, hypothermia, hemodilution The largest part of the mammary gland rests on the. - ✔✔Pectoralis major muscle and serratus anterior Which of the following is the surgical goal for breast conserving surgery? - ✔✔Removal of cancerous mass with a margin of normal tissue The RNFA with the vascular surgery service is preparing to discharge Mark Weston, a 51 - year-old male who recently had endovascular surgery. He will be taking anticoagulation therapy for the next 12 weeks. What statement regarding anticoagulation therapy, that is relevant to Mark, is true? - ✔✔Do not use tools such as saws or hammers, which could lead to an accident. Identify from the following, the correct branch of the Left main coronary artery. - ✔✔Circumflex coronary artery The Doppler transducer is the most widely used instrument for vascular study. What statement regarding a Doppler is true? - ✔✔Water-soluble gel is needed when the Doppler is used on intact skin Disadvantage in the use of a shunt during CEA. - ✔✔Possible dislodging of debris with insertion. Audible facial nerve monitors (NIMS) are used intraoperatively during procedures in which the facial nerve is at risk for injury. Why is communication with the anesthesia provider important when assisting in procedures involve the facial nerve? - ✔✔muscle relaxants, paralyzing agents, and some local anesthetics must be avoided. A portion of a parathyroid gland must remain for which of the following reasons? - ✔✔prevent hypocalcemia and its complications. There are several risk factors associated with dehiscence. Which of the following can be controlled by the RNFA? - ✔✔Sutures placed too close together
The major arterial blood supply to the descending colon is provided by which of the following? - ✔✔Left Colic Artery Josh Tremain, a 28 - year-old firefighter, sustained significant full-thickness burns when he fell through the roof of a burning building while fighting an explosive fire. What surgical treatments may Josh need? - ✔✔Debridement and monitoring of full-thickness skin regeneration Marissa Walton is transferred to the OR from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia. What important preparation for the procedure should be performed before Marissa arrives in the OR? - ✔✔Prewarm the OR to above the ambient high temperature for an adult. The colon wall has five distinct layers that include which of the following? - ✔✔Mucosa Before reaching the rectus abdominis muscle during surgical exposure, the surgeon must first progress through which of the following? - ✔✔Preperitoneal fat Identify the triad of anatomic sites of abdominal wall weakness with a potential for hernias. - ✔✔Inguinal canal, femoral rings, umbilicus What technologic characteristic of robotic surgery provides a superior indication for robotic-assisted laparoscopic cholecystectomy? - ✔✔The magnified three-dimensional picture may reduce bile duct injuries during dissection. Which of the following supplies blood to the transverse colon? - ✔✔Middle colic artery Which of the following is a "triangle" anatomic landmark in surgical removal of the gallbladder, and may be remembered by the 3 C's: cystic duct, common hepatic duct and cystic artery? - ✔✔Calots Describe the internal inguinal ring - ✔✔A natural opening in the transversalis fascia
Changes to the elderly person's skeleton can present challenges to the intraoperative team. In terms of additional attention and care, what intervention can the intraoperative team provide? - ✔✔Position the patient using appropriate padding and joint protection devices. An important aspect to bone healing that is preserved through intramedullary reaming is which of the following? - ✔✔Maintenance of fracture hematoma Which of the following is a complication of patellectomy? - ✔✔Reduced knee extension Which of the following is not included in the terrible triad? - ✔✔PCL Tear The rotator cuff consists of which group of muscles? - ✔✔Supraspinatus, infraspinatus, teres minor, and subscapularis Which of the following regarding PMMA ( bone cement) is not an affect local tissue? - ✔✔Skin burns due to exothermic reaction Infants and children with severe gastroesophageal (GE) reflux can have life-threatening complications, including obstructive apnea, aspiration pneumonia, esophagitis, and failure to thrive. What is the name of the procedure, performed open or laparoscopically, that is designed to create a competent antireflux barrier? - ✔✔Nissen fundoplication Your 12 - year-old patient is scheduled for a laparoscopic hernia repair. During the preoperative assessment, the RNFA notes mild myotonia congenita. Themmother states that she is worried about anesthesia because her husband's brother died many years ago when he became very feverish during surgery and they could not cool him. The RNFA's appropriate risk reduction strategy in this situation would be to: - ✔✔perform a careful assessment of family history to identify risk for developing malignant hyperthermia (MH) A patient presents to the OR with an injury to the anterior chest from blunt force trauma. The RNFA can expect damage to which of the following areas? - ✔✔Right Ventricle
Which of the following is a contraindication to using autotransfusion as a blood replacement source? - ✔✔Blood contaminated with food, bowel contents, or antibiotic irrigation You examine a comatose patient in the emergency room. His wife relates that her husband was struck accidentally in his "temple" by a baseball. After an initial period of unconsciousness, he seemed to be okay but later became drowsy and comatose. You suspect that the patient is suffering from: - ✔✔An Epidural hematoma If the injury to the patient is a result of a violent crime, the team must give special attention to preservation of evidence during the course of patient care. When clothing is removed from the patient, why must it be placed and secured in a paper bag rather than a plastic bag? - ✔✔Plastic bags may trap moisture and allow mold growth, destroying evidence. During a MIS hysterectomy, this ligament is divided when an oophorectomy is included in the procedure:
- ✔✔Infundibulopelvic During a THA using the posterior lateral approach, the RNFA will dislocate the head of the femur using: - ✔✔Flexion, adduction, external rotation An elevation of which lab values is indicative of acute pancreatitis resulting from a blockage in the Ampulla of Vater? - ✔✔Amylase, lipase There are disease processes that cause aortic aneurysms to develop. Which of the following is not noted within this list of causative disease processes? - ✔✔Rheumatic Fever Which of the following is contained within the carotid sheath? - ✔✔Vagus Nerve Inadvertent removal of the parathyroid glands may result in: - ✔✔Hypocalcemia Identify the fascia which is an extension of the internal oblique muscle and covers the spermatic cord. - ✔✔Cremaster
Which of the following is not a reason to convert a case from laparoscopic to an open abdominal case? - ✔✔Lack of warmer for insufflation gas The absence of distinct teniae serves as a visual landmark for what abdominal structure? - ✔✔Upper margin of the rectum What structures are located in the inguinal canal? - ✔✔Spermatic cord / Round ligament The teniae coli consist of how many longitudinal bands of muscle.along the length of the colon? - ✔✔ 3 A benefit to the patient undergoing SILS procedure which of the following? - ✔✔Less postoperative pain The incision used specifically for an open appendectomy is known as: - ✔✔McBurney The patient is placed in what position for open cholecystectomy? - ✔✔Supine From the following, which is a possible benefit to the paramedian incision? - ✔✔decreased risk for hernia Which of the following is the most common non-emergent abdominal surgery in the U.S.? - ✔✔Cholecystectomy Closed thoracostomy will require which of the following? - ✔✔chest catheters and water-seal drainage Fibrous bands of tissue found between abdominal structures that are not normally connected are known as: - ✔✔Adhesions The mesh-plug open hernia repair technique is indicated for which type(s) of hernias? - ✔✔Recurrent Indirect inguinal hernias
During robotic hysterectomy, the patient is placed in steep trendelenburg position. Which of the following is complication that can result from extended surgical time when the patient is in steep trendelenburg? - ✔✔increased intracranial pressure The pelvic floor consists of which muscle groups? - ✔✔Levator ani and coccygeal muscles The ovarian artery is a branch of which vessel? - ✔✔Aorta The innermost membrane of of the brain is known as: - ✔✔Pia Mater Pressure against which cranial nerve accounts for pupillary dilation when temporal lobe herniation is present? - ✔✔Cranial Nerve III Identify the dura fold that separates the right and left cerebral hemispheres. - ✔✔Falx cerebri The trigeminal nerve provides motor innervation to which muscle group? - ✔✔Muscle of mastication Primary divisions of a nerve are known as: - ✔✔Rami Surgeons use open reduction and internal fixation (ORIF) when they are unable to reduce a fracture using closed reduction and skeletal traction is not indicated. What would be an advantage for an open rather than a closed reduction technique? - ✔✔Direct observation and verification of fracture alignment During a total hip arthroplasty, the instrument used to access the femoral canal is the _. - ✔✔Box osteotome The use of polymethyl methacrylate (PMMA, or bone cement) can result in adverse patient reactions. Which of the following is considered an adverse patient reaction? - ✔✔Transient hypotension The connective tissue that covers all bone and supplies nutrients is known as _. - ✔✔Periosteum
There are _main coronary arteries which originate in the. - ✔✔ 2 , sinuses of Valsalva Of the nerves that are associated with the thyroid gland, which one can be affected by compression resulting from an enlarged left atrium? - ✔✔Left recurrent laryngeal nerve Another name for the left colic flexure is _. - ✔✔splenic flexure The ligament that connects the laminae of the spine is known as: - ✔✔Ligamentum Flavum Of the following, which is not included in the 5 P's of compartment syndrome? - ✔✔Pulses Hesselbach triangle describes the location of the hernia. Which of the following structures compromise the medial border of the triangle? - ✔✔Lateral edge of the rectus abdominus muscle Nipple discharge is more commonly associated with benign breast lesions than with cancer; however, discharge is usually significant only if it is spontaneous, persistent, and: - ✔✔Bloody Select the statement that best describes fine needle aspiration of a suspicious breast mass. - ✔✔The aspirate fluid is cytologically examined Velour grafts are impregnated which of the following to ease handling without the need to preclot? - ✔✔Gelatin Abdominal aortic aneurysms (AAAs), which account for most aneurysms, occur primarily in what area? - ✔✔between the renal arteries and the aortic bifurcation The internal mammary arteries are frequently used as grafts during coronary bypass surgery. Where are they located? - ✔✔They branch from the subclavian arteries
An interventional radiology procedure used to open a blocked or narrowed blood vessel as a result of atherosclerosis is a(n): - ✔✔Angioplasty Select the procedure that is designed for the relief of pharyngeal obstruction. - ✔✔Tonsillectomy The supraglottis, glottis, and the subglottis represent three portions of which structure of the throat? - ✔✔Larynx In renal transplantation a kidney with artery(ies) is preferred. - ✔✔Single The phrenic nerve innervates which structure? - ✔✔The Diaphragm Select the statement that best reflects the functional components of the gastrointestinal (GI) tract. - ✔✔The alimentary canal extends from the mouth to the anus. The gastric veins drain into which vein? - ✔✔Portal Vein The transverse colon ends at the. - ✔✔splenic flexure Select the triad of the boundaries of the Hesselbach triangle. - ✔✔Inguinal ligament, rectus abdominis muscle, deep epigastric vessels Blood supply to the jejunum and the ileum come entirely from branches of the: - ✔✔Superior mesenteric artery An indication for liver transplantation would be: - ✔✔Primary Hepatic Cancer Which nodes in the lymphatic system are responsible for drainage from the mouth, lips, and external nose? - ✔✔Submandibular
Which of the following is true regarding CSF in the brain? - ✔✔The fluid does not play a significant role in supplying nutrition to the structures it bathes Of the following, which is not a symptom of compartment syndrome? - ✔✔Moderate Pain Replantation is an attempt to reattach a completely amputated digit or other body part. Good candidates for replantation are those with the following amputations: - ✔✔almost any body part of a child. Bone graft that is sealed in a sterile labeled envelope from a tissue transplant company and stored in a vacuum-sealed freezer and monitored with an alarm would be considered a/an: - ✔✔Allograft A herniated disc most commonly occurs in which section of the vertebral column? - ✔✔Lumbar After retracting the nerve roots during a laminectomy, this structure is incised before getting to the disc.
- ✔✔Posterior longitudinal ligament Femoral neck fractures are more common in women than men for which of the following reasons? - ✔✔Osteoporosis Which of the following is the instrument of choice in removing a foreign body from an infant or child's airway? - ✔✔Rigid Bronchoscope The most significant consideration when caring for pediatric patients that is not of concern when caring for adults is: - ✔✔from birth onward, the child is in a continual state of development and physiologic change. Which of the following is an indication for damage control surgery? - ✔✔Coagulopathy A 2 6 - year-old female is rushed to the operating room after being hit by a small truck as she was riding her bicycle through a busy intersection. She has sustained rib fractures and several fractured transverse vertebral processes. Renal injury is suspected. As the perioperative nurse prepares to insert a urinary
catheter, she notices blood at the urinary meatus. What should the nurse's next action be? - ✔✔Discontinue the catheter insertion Select the injury or condition that reflect probable child abuse or neglect. - ✔✔Severe diaper rash with the presence of ammonia burns. Matthew Ryan, a 9 - year-old boy, is admitted to the emergency department for a sledding accident, when he lost control of his sled and crashed into a tree. He is pale and in pain; his abdomen is tender and firm to palpation. The CT scan suggests rupture of the spleen with internal bleeding. Matthew's scheduled surgery will be a/an: - ✔✔open total splenectomy. Which of the following is a routine part of preventing cross-contamination? - ✔✔restricting personnel movement, closing doors, minimizing talking Discharge planning begins during the. - ✔✔Assessment Phase Creating a pneumoperitoneum can cause problems with patients who 1. Have respiratory disease 2. Have sickle cell disease 3. Have cataracts 4. Have glaucoma 5. Are morbidly obese - ✔✔Not 1 and 2 Cold, clammy skin may be a sign of: - ✔✔Anxiety Key points for implementing safe practices include - ✔✔obtaining medications for only one patient at a time, avoiding distractions and interruptions when preparing medications, preparing the medication as close as possible to the time of administration, using safe injection practices Badges worn by pregnant personnel should be worn at waist level and read every: - ✔✔a month General anesthesia with intubation is generally recommended for laparoscopic procedures because of the 1. Need to use muscle relaxant to allow for abdominal insufflation 2. Need to control and increase ventilation to compensate for hypocarbia and respiratory acidosis resulting from absorption of CO 2 3. Exaggerated patient positions that can be very uncomfortable for the patient 4. Potential for patient movement, coughing, or bucking that can increase intra-abdominal pressure. - ✔✔ 1 , 2 , 3 , and 4
