RMA Surgical Assisting and Minor Surgery 1 — Questions and Answers

Question 1: What is the primary purpose of using sterile technique during a minor surgical procedure?

To reduce the time required to complete the procedure
To prevent introduction of microorganisms that could cause infection at the surgical site (Correct answer)
To ensure all instruments are visible to the surgeon at all times
To comply with insurance billing requirements for surgical procedures

Correct answer: To prevent introduction of microorganisms that could cause infection at the surgical site

Sterile technique prevents contamination of the sterile field and surgical site with microorganisms, thereby reducing the risk of surgical site infection (SSI).

Sterile technique (also called surgical asepsis) involves creating and maintaining a microorganism-free environment around the surgical site and on all instruments and materials that will contact the wound. Key principles include: only sterile items touch the sterile field, sterile persons touch only sterile items, unsterile persons touch only unsterile items, if in doubt — it's not sterile, and the sterile field must be kept within the direct visual field. Medical assistants who assist with minor office procedures must be trained in setting up a sterile field, adding sterile supplies to the field, draping, and maintaining sterility throughout the procedure to prevent surgical site infections.

Question 2: Which suture material is ABSORBABLE and does not require removal?

Nylon (Ethilon)
Polypropylene (Prolene)
Polyglycolic acid (Dexon) (Correct answer)
Silk

Correct answer: Polyglycolic acid (Dexon)

Polyglycolic acid (Dexon) and other synthetic absorbable sutures such as polyglactin (Vicryl) are broken down by hydrolysis in the body over time and do not require removal.

Sutures are classified as absorbable (broken down by the body) or non-absorbable (must be removed). Absorbable sutures include: plain gut (natural, absorbed in 7–10 days), chromic gut (10–21 days), polyglycolic acid/Dexon (21–28 days), polyglactin/Vicryl (28–35 days), and poliglecaprone/Monocryl (90–120 days). Non-absorbable sutures include nylon (Ethilon), polypropylene (Prolene), polyester, and silk — these must be removed after healing. Medical assistants must know which sutures are used for which layers and be prepared to assist with suture selection and removal at appropriate follow-up appointments.

Question 3: When setting up a sterile field for a minor procedure, which action would CONTAMINATE the field?

Opening sterile packages by peeling apart the edges away from the sterile field
Placing sterile items in the center of the sterile drape
Reaching across or above the sterile field (Correct answer)
Holding sterile instruments above waist level

Correct answer: Reaching across or above the sterile field

Reaching across or above the sterile field risks contamination because non-sterile clothing, skin, or hair may contact or shed microorganisms onto the sterile field.

To maintain sterility of a surgical field, medical assistants must never: reach across a sterile field (reaching over can drop contaminants from clothing or hands), allow a sterile drape to fall below table level (edges below the table level are considered contaminated), turn their back on the sterile field, or allow a sterile item to come into contact with any unsterile surface. A one-inch border around the edge of the sterile drape is considered contaminated. Sterile gloves must be worn when touching items on the field. Any contamination must be immediately acknowledged and the field must be re-established. Medical assistants must communicate any breaks in sterile technique immediately.

Question 4: Which local anesthetic is most commonly used for minor office procedures such as laceration repair and skin biopsies?

Bupivacaine (Marcaine)
Lidocaine (Xylocaine) (Correct answer)
Procaine (Novocain)
Tetracaine

Correct answer: Lidocaine (Xylocaine)

Lidocaine (Xylocaine) is the most widely used local anesthetic for minor office procedures due to its rapid onset (within 5 minutes), effectiveness, and favorable safety profile.

Lidocaine is an amide-type local anesthetic that works by blocking sodium channels in nerve cell membranes, preventing the initiation and conduction of nerve impulses. It has an onset of 1–5 minutes and a duration of 1–2 hours (up to 4 hours when combined with epinephrine). Lidocaine with epinephrine is preferred for areas with good blood supply to reduce bleeding and prolong anesthesia but should NOT be used in end-arterial areas (fingers, toes, nose, ears, penis) due to the risk of tissue ischemia. Medical assistants prepare lidocaine for the physician, assist with administration, and monitor patients for adverse reactions.

Question 5: When assisting with the removal of a skin lesion, the medical assistant should prepare which type of container for the specimen?

A dry container without any solution
A container with normal saline
A formalin-filled (10% neutral buffered formalin) container (Correct answer)
A container filled with sterile water

Correct answer: A formalin-filled (10% neutral buffered formalin) container

Tissue specimens sent for histopathological analysis (biopsy) are preserved in 10% neutral buffered formalin (NBF), which fixes the tissue and prevents cellular decomposition.

10% neutral buffered formalin (NBF) is the standard fixative for tissue specimens submitted for histopathology. Formalin cross-links proteins, halting cellular autolysis and preserving tissue architecture and cellular morphology so pathologists can examine the tissue under the microscope. The specimen container must be labeled with the patient's full name, date, site of biopsy, and type of tissue. An adequate amount of formalin (at least 10 times the volume of the tissue) should be used. Medical assistants must prepare the correctly labeled formalin container before the procedure, place the excised specimen in it immediately, and arrange prompt transport to the laboratory.

Question 6: After a minor surgical procedure, what instructions should the medical assistant provide to the patient regarding wound care?

Soak the wound in water daily and remove the bandage after 24 hours
Keep the wound dry for the first 24–48 hours, keep it clean, and watch for signs of infection (Correct answer)
Apply hydrogen peroxide to the wound daily to kill bacteria
Cover the wound with a wet gauze dressing at all times

Correct answer: Keep the wound dry for the first 24–48 hours, keep it clean, and watch for signs of infection

Standard post-procedure wound care includes keeping the wound dry for the first 24–48 hours, then gently cleaning it, keeping it covered with a clean dressing, and monitoring for signs of infection.

Proper post-procedure wound care instructions given by medical assistants should include: keep the wound dry and covered for the first 24–48 hours; after that, gently clean with mild soap and water, pat dry, and apply a thin layer of antibiotic ointment (if instructed) and a clean bandage; avoid submerging in water (no swimming or bathing) until instructed; do not pick at the wound or remove forming scabs; watch for signs of infection (increasing redness, warmth, swelling, purulent discharge, fever, red streaks from the wound); take prescribed antibiotics as directed; and return for suture removal as scheduled. Medical assistants should provide both verbal and written instructions and document patient education in the EHR.

RMA Surgical Assisting and Minor Surgery 1

What is the primary purpose of using sterile technique during a minor surgical procedure?