NIFA Perioperative Practice Exam — 1 to
200 (Mixed Format)
1. (MCQ) The sterile field is considered contaminated if: A. a sterile glove touches a sterile
instrument
B. a sterile drape is kept above waist level
C. a nonsterile person reaches over the field
D. sterile instruments remain covered
Answer: C.
Explanation: Reaching over a sterile field by nonsterile personnel contaminates it; sterile items
above waist level may be okay, but crossing by nonsterile persons is contamination.
2. (T/F) The scrub nurse may adjust the light without breaking sterile technique if they touch
only sterile parts of the light handle.
Answer: True.
Explanation: Adjusting lights via sterile handle kept within sterile field is allowed; care to
maintain sterility is required.
3. (MCQ) The recommended timing for prophylactic IV antibiotics to prevent SSI is: A. at skin
incision
B. within 60 minutes before incision (120 min for some agents)
C. after cord clamp in C-section
D. immediately at PACU arrival
Answer: B.
Explanation: Optimal timing is within 60 minutes prior to incision (120 minutes for
vancomycin/fluoroquinolones).
4. (SATA) Components of the WHO surgical safety checklist include:
A. Patient identity verification
B. Instrument sterilization cycle record review only by SPD
C. Site marking confirmation
D. Antibiotic administration check
E. Radiology report review
Answer: A, C, D.
Explanation: WHO checklist requires ID, site marking, antibiotics; instrument sterilization cycle
may be institutionally checked but not exclusively on checklist; radiology review not standard
item.
5. (MCQ) Which suture material is absorbable?
A. Polypropylene (Prolene)
,B. Nylon
C. Polyglycolic acid (Vicryl)
D. Stainless steel
Answer: C.
Explanation: Vicryl is synthetic absorbable; Prolene and nylon are nonabsorbable; steel is
nonabsorbable.
6. (T/F) A surgical count discrepancy must be resolved before closure of a body cavity.
Answer: True.
Explanation: Counts must be correct prior to wound closure to avoid retained surgical items.
7. (MCQ) The primary mechanism of action for neuromuscular blocking agents like rocuronium
is:
A. GABA potentiation
B. Acetylcholinesterase inhibition
C. Competitive blockade at nicotinic receptors
D. Opioid receptor agonism
Answer: C.
Explanation: Rocuronium competitively blocks nicotinic acetylcholine receptors at the
neuromuscular junction.
8. (SATA) Which are signs of malignant hyperthermia (MH)?
A. Rapid rise in end-tidal CO₂
B. Muscle rigidity (masseter spasm)
C. Hypothermia
D. Hyperkalemia
E. Bradycardia
Answer: A, B, D.
Explanation: MH presents with hypercarbia, rigidity, hyperkalemia, and hyperthermia;
bradycardia is not typical early.
9. (MCQ) The tourniquet inflation pressure for an adult lower extremity is typically set to:
A. 50 mmHg
B. Systolic BP + 100–150 mmHg
C. Diastolic BP + 20 mmHg
D. Systolic BP − 20 mmHg
Answer: B.
Explanation: Lower extremity tourniquet pressures commonly ~100–150 mmHg above systolic
BP, adjusted per protocol.
10. (T/F) A surgical specimen placed in formalin should be labeled with patient identifiers and a
specimen label that includes the anatomic source.
Answer: True.
Explanation: Proper labeling is mandatory for pathology and chain of custody.
,11. (MCQ) Which instrument is used to grasp bowel during abdominal surgery?
A. Kocher clamp
B. Babcock forceps
C. Allis clamp
D. Heaney clamp
Answer: B.
Explanation: Babcock atraumatic forceps are used for bowel; Allis is more traumatic; Kocher
for heavy tissue; Heaney is OB/GYN.
12. (SATA) Absolute contraindications to laparoscopy include:
A. Hemodynamic instability
B. Intra-abdominal adhesions suspected
C. Uncorrected coagulopathy
D. Recent myocardial infarction (unstable)
Answer: A, C, D.
Explanation: Hemodynamic instability, uncorrected coagulopathy, and unstable MI are
contraindications; adhesions are relative and increase risk.
13. (MCQ) The most appropriate airway device for an elective general anesthetic with positive
pressure ventilation is:
A. Nasopharyngeal airway
B. Laryngeal mask airway (LMA)
C. Endotracheal tube (ETT)
D. Oropharyngeal airway
Answer: C.
Explanation: ETT secures airway for controlled ventilation; LMAs used for selected cases.
14. (T/F) Heated humidifiers and warming blankets decrease the risk of perioperative
hypothermia.
Answer: True.
Explanation: Active warming reduces hypothermia and related complications.
15. (MCQ) The best management of a partial airway obstruction from the tongue in an
unconscious patient is:
A. Heimlich maneuver
B. Jaw thrust and chin lift with oropharyngeal airway (if no gag)
C. Nasogastric tube placement
D. Give naloxone
Answer: B.
Explanation: Basic airway maneuvers and adjuncts relieve tongue obstruction; Heimlich is for
foreign body in conscious patient.
16. (SATA) Components of informed consent include:
A. Disclosure of risks/benefits
B. Voluntary patient agreement
, C. Physician’s plan to withhold information
D. Explanation of alternatives
Answer: A, B, D.
Explanation: Consent requires disclosure, voluntary agreement, and alternatives; withholding
info without justification violates consent.
17. (MCQ) Which sterilization method is best for heat-sensitive endoscopes?
A. Steam autoclave
B. Ethylene oxide (ETO) or low-temperature hydrogen peroxide gas plasma
C. Boiling water
D. Dry heat
Answer: B.
Explanation: ETO or low-temp gas plasma are used for heat/moisture sensitive equipment.
18. (T/F) A fenestrated drape’s fenestration should be placed after the sterile skin prep and
allowed to touch nonsterile surfaces.
Answer: False.
Explanation: Fenestrated drape should be placed without contaminating the sterile drape and
must not touch nonsterile surfaces.
19. (MCQ) Select the best suture knot for securing a vessel ligature:
A. Simple interrupted skin suture
B. Square (reef) knot with instrument tie and additional throws
C. Mattress suture
D. Running locked skin stitch
Answer: B.
Explanation: Square knots with extra throws provide secure ligation for vessels.
20. (SATA) What factors increase the risk of surgical site infection?
A. Diabetes mellitus
B. Smoking
C. Perioperative hyperglycemia
D. Prophylactic antibiotics given 30 minutes prior to incision
Answer: A, B, C.
Explanation: Diabetes, smoking, and hyperglycemia increase SSI risk; proper-timed antibiotics
decrease risk.
21. (MCQ) A chest tube placed for pneumothorax should be positioned:
A. High anterior for air, low posterior for fluid
B. Always midline
C. Low anterior for air
D. Superomedial for fluid only
Answer: A.
Explanation: Air migrates superiorly — high anterior placement for pneumothorax; fluid
collects dependent/posteriorly.
200 (Mixed Format)
1. (MCQ) The sterile field is considered contaminated if: A. a sterile glove touches a sterile
instrument
B. a sterile drape is kept above waist level
C. a nonsterile person reaches over the field
D. sterile instruments remain covered
Answer: C.
Explanation: Reaching over a sterile field by nonsterile personnel contaminates it; sterile items
above waist level may be okay, but crossing by nonsterile persons is contamination.
2. (T/F) The scrub nurse may adjust the light without breaking sterile technique if they touch
only sterile parts of the light handle.
Answer: True.
Explanation: Adjusting lights via sterile handle kept within sterile field is allowed; care to
maintain sterility is required.
3. (MCQ) The recommended timing for prophylactic IV antibiotics to prevent SSI is: A. at skin
incision
B. within 60 minutes before incision (120 min for some agents)
C. after cord clamp in C-section
D. immediately at PACU arrival
Answer: B.
Explanation: Optimal timing is within 60 minutes prior to incision (120 minutes for
vancomycin/fluoroquinolones).
4. (SATA) Components of the WHO surgical safety checklist include:
A. Patient identity verification
B. Instrument sterilization cycle record review only by SPD
C. Site marking confirmation
D. Antibiotic administration check
E. Radiology report review
Answer: A, C, D.
Explanation: WHO checklist requires ID, site marking, antibiotics; instrument sterilization cycle
may be institutionally checked but not exclusively on checklist; radiology review not standard
item.
5. (MCQ) Which suture material is absorbable?
A. Polypropylene (Prolene)
,B. Nylon
C. Polyglycolic acid (Vicryl)
D. Stainless steel
Answer: C.
Explanation: Vicryl is synthetic absorbable; Prolene and nylon are nonabsorbable; steel is
nonabsorbable.
6. (T/F) A surgical count discrepancy must be resolved before closure of a body cavity.
Answer: True.
Explanation: Counts must be correct prior to wound closure to avoid retained surgical items.
7. (MCQ) The primary mechanism of action for neuromuscular blocking agents like rocuronium
is:
A. GABA potentiation
B. Acetylcholinesterase inhibition
C. Competitive blockade at nicotinic receptors
D. Opioid receptor agonism
Answer: C.
Explanation: Rocuronium competitively blocks nicotinic acetylcholine receptors at the
neuromuscular junction.
8. (SATA) Which are signs of malignant hyperthermia (MH)?
A. Rapid rise in end-tidal CO₂
B. Muscle rigidity (masseter spasm)
C. Hypothermia
D. Hyperkalemia
E. Bradycardia
Answer: A, B, D.
Explanation: MH presents with hypercarbia, rigidity, hyperkalemia, and hyperthermia;
bradycardia is not typical early.
9. (MCQ) The tourniquet inflation pressure for an adult lower extremity is typically set to:
A. 50 mmHg
B. Systolic BP + 100–150 mmHg
C. Diastolic BP + 20 mmHg
D. Systolic BP − 20 mmHg
Answer: B.
Explanation: Lower extremity tourniquet pressures commonly ~100–150 mmHg above systolic
BP, adjusted per protocol.
10. (T/F) A surgical specimen placed in formalin should be labeled with patient identifiers and a
specimen label that includes the anatomic source.
Answer: True.
Explanation: Proper labeling is mandatory for pathology and chain of custody.
,11. (MCQ) Which instrument is used to grasp bowel during abdominal surgery?
A. Kocher clamp
B. Babcock forceps
C. Allis clamp
D. Heaney clamp
Answer: B.
Explanation: Babcock atraumatic forceps are used for bowel; Allis is more traumatic; Kocher
for heavy tissue; Heaney is OB/GYN.
12. (SATA) Absolute contraindications to laparoscopy include:
A. Hemodynamic instability
B. Intra-abdominal adhesions suspected
C. Uncorrected coagulopathy
D. Recent myocardial infarction (unstable)
Answer: A, C, D.
Explanation: Hemodynamic instability, uncorrected coagulopathy, and unstable MI are
contraindications; adhesions are relative and increase risk.
13. (MCQ) The most appropriate airway device for an elective general anesthetic with positive
pressure ventilation is:
A. Nasopharyngeal airway
B. Laryngeal mask airway (LMA)
C. Endotracheal tube (ETT)
D. Oropharyngeal airway
Answer: C.
Explanation: ETT secures airway for controlled ventilation; LMAs used for selected cases.
14. (T/F) Heated humidifiers and warming blankets decrease the risk of perioperative
hypothermia.
Answer: True.
Explanation: Active warming reduces hypothermia and related complications.
15. (MCQ) The best management of a partial airway obstruction from the tongue in an
unconscious patient is:
A. Heimlich maneuver
B. Jaw thrust and chin lift with oropharyngeal airway (if no gag)
C. Nasogastric tube placement
D. Give naloxone
Answer: B.
Explanation: Basic airway maneuvers and adjuncts relieve tongue obstruction; Heimlich is for
foreign body in conscious patient.
16. (SATA) Components of informed consent include:
A. Disclosure of risks/benefits
B. Voluntary patient agreement
, C. Physician’s plan to withhold information
D. Explanation of alternatives
Answer: A, B, D.
Explanation: Consent requires disclosure, voluntary agreement, and alternatives; withholding
info without justification violates consent.
17. (MCQ) Which sterilization method is best for heat-sensitive endoscopes?
A. Steam autoclave
B. Ethylene oxide (ETO) or low-temperature hydrogen peroxide gas plasma
C. Boiling water
D. Dry heat
Answer: B.
Explanation: ETO or low-temp gas plasma are used for heat/moisture sensitive equipment.
18. (T/F) A fenestrated drape’s fenestration should be placed after the sterile skin prep and
allowed to touch nonsterile surfaces.
Answer: False.
Explanation: Fenestrated drape should be placed without contaminating the sterile drape and
must not touch nonsterile surfaces.
19. (MCQ) Select the best suture knot for securing a vessel ligature:
A. Simple interrupted skin suture
B. Square (reef) knot with instrument tie and additional throws
C. Mattress suture
D. Running locked skin stitch
Answer: B.
Explanation: Square knots with extra throws provide secure ligation for vessels.
20. (SATA) What factors increase the risk of surgical site infection?
A. Diabetes mellitus
B. Smoking
C. Perioperative hyperglycemia
D. Prophylactic antibiotics given 30 minutes prior to incision
Answer: A, B, C.
Explanation: Diabetes, smoking, and hyperglycemia increase SSI risk; proper-timed antibiotics
decrease risk.
21. (MCQ) A chest tube placed for pneumothorax should be positioned:
A. High anterior for air, low posterior for fluid
B. Always midline
C. Low anterior for air
D. Superomedial for fluid only
Answer: A.
Explanation: Air migrates superiorly — high anterior placement for pneumothorax; fluid
collects dependent/posteriorly.
