P E R I O P E R AT I V E N U R S I N G • S U R G I C A L F I R S T A SS I S T I N G C E RT I F I C AT I O N
PRACTICE
NIFA PERIOPERATIVE QUIZ 1 & 2
Comprehensive Practice Exam – 2026/2027 EDITION
200 Questions (Comprehensive) 10 Blueprint Domains AORN-Aligned Standards
Answers & Rationales
I M P O RTA N T N O T I C E
This is an original practice examination built on the combined scope of a perioperative
nursing / surgical first assisting curriculum (preoperative assessment, asepsis and sterile
technique, surgical safety and counts, intraoperative roles, positioning, instrumentation,
anesthesia monitoring, laparoscopic and robotic surgery, electrosurgery and hazards, and
professional practice). It is not the actual NIFA quiz, is not affiliated with or endorsed by
the National Institute for First Assistants (NIFA), the Association of periOperative
Registered Nurses (AORN), or the Competency & Credentialing Institute (CCI), and
contains no proprietary exam items. It is intended for self-study and preparation only.
Content reflects widely taught perioperative standards — including sterile technique, the
Universal Protocol surgical timeout, count procedures, and safety practices aligned with
AORN-style guidance. Actual institutional policies, the governing surgeon and facility, and
the most current published guidelines always control real patient care.
HOW TO USE THIS EXAM
Sit all 200 questions in one long session, or split them into two 100-question sittings to
mirror a Quiz 1 / Quiz 2 sequence. Correct answers are marked [CORRECT] with a
rationale addressing the distractors — cover the marked line to self-test. Five case-study
blocks (shaded boxes) present unfolding perioperative scenarios with linked interpretation-
and-action items. Domains span preoperative through professional practice, weighting the
high-risk safety topics perioperative teams face daily.
CONTENTS
1. Sec 1 Preoperative Assessment & Patient Preparation (30): Consent • Health Literacy •
Risk Factors • NPO
2. Sec 2 Asepsis, Sterile Technique & Infection Control (30): Surgical Scrub • Sterile Field •
Precautions
3. Sec 3 Surgical Safety & Count Procedures (25): Timeout • Site Marking • Counts • RSI
Prevention
Page 1 of 57
, NIFA Perioperative Quiz 1 & 2 —Comprehensive Practice Exam (2026/2027 Edition)
4. Sec 4 Intraoperative Nursing & Circulating Nurse Roles (25): Responsibilities • Instruments
• Specimens
5. Sec 5 Surgical Positioning & Patient Safety (20): Position Risks • Pressure Injury •
Hypothermia
6. Sec 6 Instrumentation, Sutures & Wound Closure (15): Suture Selection • Needles •
Stapling
7. Sec 7 Anesthesia Monitoring & Pain Management (15): Sedation Levels • Pulse Oximetry •
PONV
8. Sec 8 Laparoscopic & Robotic Surgery (15): Pneumoperitoneum • CO2 Insufflation •
Conversion
9. Sec 9 Electrosurgery, Fire Safety & Hazards (10): ESU • Grounding • Surgical Smoke •
Lasers
10. Sec 10 Professional Issues & Certification (15): NIFA • RNFA Scope • CCI Credentials •
Documentation
Page 2 of 57
, NIFA Perioperative Quiz 1 & 2 —Comprehensive Practice Exam (2026/2027 Edition)
Section 1: Preoperative Assessment & Patient Preparation – Informed
Consent, Risk Factors, Health Literacy (30 questions)
Q1: The primary goal of perioperative nursing care is to:
A. Complete the surgeon's schedule on time
B. Ensure patient safety and achieve optimal surgical outcomes [CORRECT]
C. Minimize the cost of disposable supplies
D. Document faster than other units
Correct Answer: B
Rationale: Every perioperative intervention — assessment, safety checks, sterile technique — exists to
keep the patient safe and produce the best possible outcome; schedule speed and cost are operational
concerns that never override safety.
Q2: Informed consent for surgery is obtained by the:
A. Circulating nurse
B. Scrub nurse
C. Surgeon performing the procedure [CORRECT]
D. Anesthesia technician
Correct Answer: C
Rationale: The surgeon who will perform the operation must explain the procedure, risks, benefits, and
alternatives so consent is informed; nurses verify the consent exists and the patient understands, but
they do not obtain consent.
Q3: On admission, the patient says, "I'm not really sure what they're going to do to me." The circulating
nurse should FIRST:
A. Have the patient sign the consent anyway to avoid delay
B. Notify the surgeon so the procedure, risks, and alternatives can be re-explained before surgery
[CORRECT]
C. Explain the operation herself and obtain a new consent
D. Cancel the surgery unilaterally
Correct Answer: B
Rationale: Consent must reflect genuine understanding — the nurse's duty is to advocate and escalate
to the surgeon for clarification; proceeding with a doubtful consent and nurse-obtained consents are both
outside legal scope, and nurses do not cancel surgery alone.
Q4: Written preoperative education materials are best prepared at approximately which reading level?
A. Graduate level
B. 5th grade level [CORRECT]
C. 12th grade level
D. Medical textbook level
Correct Answer: B
Rationale: Health-literacy guidance recommends patient materials at about a 5th-grade level so the
broadest patient population can comprehend instructions; higher-level materials systematically exclude
patients with limited literacy.
Page 3 of 57
, NIFA Perioperative Quiz 1 & 2 —Comprehensive Practice Exam (2026/2027 Edition)
Q5: The best way to verify that a patient understood preoperative teaching is to:
A. Ask "Do you have any questions?" and record a "no"
B. Use teach-back: ask the patient to explain the instructions in his or her own words [CORRECT]
C. Obtain a signature on the handout
D. Note that the handout was printed in large font
Correct Answer: B
Rationale: Teach-back demonstrates actual comprehension, exposing gaps that a polite "no questions"
response hides; signatures and font size document delivery, not understanding.
Q6: Medication reconciliation on the preoperative interview is performed primarily to:
A. Update the pharmacy's billing records
B. Identify drugs that create surgical risk (bleeding, interaction, withdrawal, hypotension) so they
can be managed per protocol [CORRECT]
C. Predict the patient's pain threshold
D. Determine insurance coverage
Correct Answer: B
Rationale: Reconciliation surfaces anticoagulants, antihypertensives, insulin, and supplements whose
perioperative continuation, dose adjustment, or withholding must be planned with the surgeon/
anesthesia team; billing and pain prediction are not its purpose.
Q7: A patient takes daily aspirin and is scheduled for elective surgery in two weeks. The nurse should
instruct the patient to:
A. Stop the aspirin immediately on her own
B. Report aspirin use to the surgical team and follow the surgeon's instructions about when and
whether to stop it [CORRECT]
C. Double the dose before surgery to "thin the blood" less
D. Ignore aspirin because it is only a vitamin
Correct Answer: B
Rationale: Aspirin's antiplatelet effect raises perioperative bleeding risk, but stopping it carries
thrombotic risk — the surgeon (often with the prescriber) decides timing; self-directed discontinuation or
dose changes are unsafe.
Q8: Per current preoperative fasting practice, a healthy adult may typically drink clear liquids up to how
long before elective surgery?
A. 30 minutes
B. 2 hours [CORRECT]
C. 12 hours
D. Clear liquids are never permitted
Correct Answer: B
Rationale: Modern fasting guidelines allow clear liquids until about 2 hours before anesthesia because
they empty from the stomach rapidly; the older 12-hour blanket restriction is outdated and needlessly
dehydrates patients.
Page 4 of 57
PRACTICE
NIFA PERIOPERATIVE QUIZ 1 & 2
Comprehensive Practice Exam – 2026/2027 EDITION
200 Questions (Comprehensive) 10 Blueprint Domains AORN-Aligned Standards
Answers & Rationales
I M P O RTA N T N O T I C E
This is an original practice examination built on the combined scope of a perioperative
nursing / surgical first assisting curriculum (preoperative assessment, asepsis and sterile
technique, surgical safety and counts, intraoperative roles, positioning, instrumentation,
anesthesia monitoring, laparoscopic and robotic surgery, electrosurgery and hazards, and
professional practice). It is not the actual NIFA quiz, is not affiliated with or endorsed by
the National Institute for First Assistants (NIFA), the Association of periOperative
Registered Nurses (AORN), or the Competency & Credentialing Institute (CCI), and
contains no proprietary exam items. It is intended for self-study and preparation only.
Content reflects widely taught perioperative standards — including sterile technique, the
Universal Protocol surgical timeout, count procedures, and safety practices aligned with
AORN-style guidance. Actual institutional policies, the governing surgeon and facility, and
the most current published guidelines always control real patient care.
HOW TO USE THIS EXAM
Sit all 200 questions in one long session, or split them into two 100-question sittings to
mirror a Quiz 1 / Quiz 2 sequence. Correct answers are marked [CORRECT] with a
rationale addressing the distractors — cover the marked line to self-test. Five case-study
blocks (shaded boxes) present unfolding perioperative scenarios with linked interpretation-
and-action items. Domains span preoperative through professional practice, weighting the
high-risk safety topics perioperative teams face daily.
CONTENTS
1. Sec 1 Preoperative Assessment & Patient Preparation (30): Consent • Health Literacy •
Risk Factors • NPO
2. Sec 2 Asepsis, Sterile Technique & Infection Control (30): Surgical Scrub • Sterile Field •
Precautions
3. Sec 3 Surgical Safety & Count Procedures (25): Timeout • Site Marking • Counts • RSI
Prevention
Page 1 of 57
, NIFA Perioperative Quiz 1 & 2 —Comprehensive Practice Exam (2026/2027 Edition)
4. Sec 4 Intraoperative Nursing & Circulating Nurse Roles (25): Responsibilities • Instruments
• Specimens
5. Sec 5 Surgical Positioning & Patient Safety (20): Position Risks • Pressure Injury •
Hypothermia
6. Sec 6 Instrumentation, Sutures & Wound Closure (15): Suture Selection • Needles •
Stapling
7. Sec 7 Anesthesia Monitoring & Pain Management (15): Sedation Levels • Pulse Oximetry •
PONV
8. Sec 8 Laparoscopic & Robotic Surgery (15): Pneumoperitoneum • CO2 Insufflation •
Conversion
9. Sec 9 Electrosurgery, Fire Safety & Hazards (10): ESU • Grounding • Surgical Smoke •
Lasers
10. Sec 10 Professional Issues & Certification (15): NIFA • RNFA Scope • CCI Credentials •
Documentation
Page 2 of 57
, NIFA Perioperative Quiz 1 & 2 —Comprehensive Practice Exam (2026/2027 Edition)
Section 1: Preoperative Assessment & Patient Preparation – Informed
Consent, Risk Factors, Health Literacy (30 questions)
Q1: The primary goal of perioperative nursing care is to:
A. Complete the surgeon's schedule on time
B. Ensure patient safety and achieve optimal surgical outcomes [CORRECT]
C. Minimize the cost of disposable supplies
D. Document faster than other units
Correct Answer: B
Rationale: Every perioperative intervention — assessment, safety checks, sterile technique — exists to
keep the patient safe and produce the best possible outcome; schedule speed and cost are operational
concerns that never override safety.
Q2: Informed consent for surgery is obtained by the:
A. Circulating nurse
B. Scrub nurse
C. Surgeon performing the procedure [CORRECT]
D. Anesthesia technician
Correct Answer: C
Rationale: The surgeon who will perform the operation must explain the procedure, risks, benefits, and
alternatives so consent is informed; nurses verify the consent exists and the patient understands, but
they do not obtain consent.
Q3: On admission, the patient says, "I'm not really sure what they're going to do to me." The circulating
nurse should FIRST:
A. Have the patient sign the consent anyway to avoid delay
B. Notify the surgeon so the procedure, risks, and alternatives can be re-explained before surgery
[CORRECT]
C. Explain the operation herself and obtain a new consent
D. Cancel the surgery unilaterally
Correct Answer: B
Rationale: Consent must reflect genuine understanding — the nurse's duty is to advocate and escalate
to the surgeon for clarification; proceeding with a doubtful consent and nurse-obtained consents are both
outside legal scope, and nurses do not cancel surgery alone.
Q4: Written preoperative education materials are best prepared at approximately which reading level?
A. Graduate level
B. 5th grade level [CORRECT]
C. 12th grade level
D. Medical textbook level
Correct Answer: B
Rationale: Health-literacy guidance recommends patient materials at about a 5th-grade level so the
broadest patient population can comprehend instructions; higher-level materials systematically exclude
patients with limited literacy.
Page 3 of 57
, NIFA Perioperative Quiz 1 & 2 —Comprehensive Practice Exam (2026/2027 Edition)
Q5: The best way to verify that a patient understood preoperative teaching is to:
A. Ask "Do you have any questions?" and record a "no"
B. Use teach-back: ask the patient to explain the instructions in his or her own words [CORRECT]
C. Obtain a signature on the handout
D. Note that the handout was printed in large font
Correct Answer: B
Rationale: Teach-back demonstrates actual comprehension, exposing gaps that a polite "no questions"
response hides; signatures and font size document delivery, not understanding.
Q6: Medication reconciliation on the preoperative interview is performed primarily to:
A. Update the pharmacy's billing records
B. Identify drugs that create surgical risk (bleeding, interaction, withdrawal, hypotension) so they
can be managed per protocol [CORRECT]
C. Predict the patient's pain threshold
D. Determine insurance coverage
Correct Answer: B
Rationale: Reconciliation surfaces anticoagulants, antihypertensives, insulin, and supplements whose
perioperative continuation, dose adjustment, or withholding must be planned with the surgeon/
anesthesia team; billing and pain prediction are not its purpose.
Q7: A patient takes daily aspirin and is scheduled for elective surgery in two weeks. The nurse should
instruct the patient to:
A. Stop the aspirin immediately on her own
B. Report aspirin use to the surgical team and follow the surgeon's instructions about when and
whether to stop it [CORRECT]
C. Double the dose before surgery to "thin the blood" less
D. Ignore aspirin because it is only a vitamin
Correct Answer: B
Rationale: Aspirin's antiplatelet effect raises perioperative bleeding risk, but stopping it carries
thrombotic risk — the surgeon (often with the prescriber) decides timing; self-directed discontinuation or
dose changes are unsafe.
Q8: Per current preoperative fasting practice, a healthy adult may typically drink clear liquids up to how
long before elective surgery?
A. 30 minutes
B. 2 hours [CORRECT]
C. 12 hours
D. Clear liquids are never permitted
Correct Answer: B
Rationale: Modern fasting guidelines allow clear liquids until about 2 hours before anesthesia because
they empty from the stomach rapidly; the older 12-hour blanket restriction is outdated and needlessly
dehydrates patients.
Page 4 of 57
