Certified Surgical Technologist (CST) Exam — Questions and Answers

Question 1: Which action is correct when a sterile team member must turn their back during a procedure?

They can turn briefly if supervised by the surgeon
They should pass behind other sterile team members only
They should never turn their back to the sterile field (Correct answer)
They may turn freely if they avoid touching anything

Correct answer: They should never turn their back to the sterile field

Sterile team members must never turn their backs to the sterile field because the back of a sterile gown is not considered sterile.

Question 2: For a patient who has been diagnosed with anxiety connected to the surgery, which of the following is not a nursing intervention?

Remove any external stimuli that may be overstimulating.
Teach the patient relaxation skills so they can feel more at ease.
Make arrangements for a social worker to visit and remain with the patient. (Correct answer)
Encourage the sufferer to express their fears in words.

Correct answer: Make arrangements for a social worker to visit and remain with the patient.

Explanation: <br> The nurse should not just contact a social worker to come and stay with the patient if the patient has been diagnosed with anxiety due to the surgical operation. In order to help the patient express their fears and to get them ready for surgery, the nurse should strive to stay with them as much as possible. Anxiety can also be reduced by teaching the patient relaxation skills and limiting outside distractions.

Question 3: A surgical technologist is setting up for a procedure and notices a wrapped instrument tray has a small, dry water stain on the outer wrap. The integrity of the packaging is not compromised, and the external chemical indicator has changed appropriately. What is the most appropriate action for the technologist to take?

Use the instruments, as the indicator change and intact wrap confirm sterility.
Wipe the stained area with a sterile towel before opening the tray.
Consider the tray contaminated and remove it from the sterile field. (Correct answer)
Remove the outer wrap and inspect the inner wrap before deciding to use the tray.

Correct answer: Consider the tray contaminated and remove it from the sterile field.

Any moisture that penetrates a sterile barrier, even if it has since dried, creates a pathway for microorganisms to enter. This is known as strike-through contamination. The presence of a water stain indicates a previous event that compromised the package's sterility, making the contents unsterile and unsafe for use.

Question 4: Which nerve is at risk during a total hip arthroplasty due to its proximity to the posterior hip capsule?

Sciatic nerve (Correct answer)
Femoral nerve
Lateral femoral cutaneous nerve
Obturator nerve

Correct answer: Sciatic nerve

The sciatic nerve passes posterior to the hip joint and is the most commonly injured nerve during posterior approach total hip arthroplasty.

Question 5: The CUSA (Cavitron Ultrasonic Surgical Aspirator) is used primarily for:

Irrigating the surgical field
Cutting bone with ultrasonic vibration
Fragmenting and aspirating soft tissue tumors with minimal blood loss (Correct answer)
Sealing blood vessels with ultrasonic energy

Correct answer: Fragmenting and aspirating soft tissue tumors with minimal blood loss

The CUSA uses ultrasonic vibration to selectively fragment soft tissue (such as tumors) while sparing blood vessels and bile ducts, then aspirates the debris.

Question 6: What is the name of the interaction between two organisms that coexist in the same space but where one benefits while the other is unaffected?

Parotid
Mitochondria
Commensalism (Correct answer)
Penrose

Correct answer: Commensalism

The correct answer is Commensalism. This term describes a symbiotic relationship where one organism benefits from the interaction, while the other organism is neither significantly harmed nor helped. Unlike mutualism (where both benefit) or parasitism (where one benefits at the expense of the other), commensalism is characterized by a neutral effect on one of the participants.

Question 7: When the surgery is finished, the patient is extubated. The mouth and tube have been suctioned, and the cuff deflated. What comes next in this procedure?

Apply cricoid pressure to the neck while carefully removing the tube with the thumb and forefinger
To make it easier to remove the tube, bend the patient's head downward and toward the chest
Insert a suction catheter into the tube and apply suction while pulling the tube out (Correct answer)
Ten more minutes of assisted ventilation should be provided using a bag attached to the ET tube

Correct answer: Insert a suction catheter into the tube and apply suction while pulling the tube out

When extubating a patient, it is essential to clear any secretions from the airway to prevent aspiration. Inserting a suction catheter into the endotracheal tube and applying suction while simultaneously removing the tube helps to remove secretions that may have accumulated. This technique minimizes the risk of the patient aspirating these secretions as the tube passes through the glottis.

Question 8: The C-arm fluoroscope is used intraoperatively primarily to:

Measure bone density
Provide real-time X-ray imaging during the procedure (Correct answer)
Monitor the patient's cardiac rhythm
Guide ultrasound-based tissue sampling

Correct answer: Provide real-time X-ray imaging during the procedure

The C-arm provides real-time fluoroscopic (X-ray) imaging during surgery, allowing visualization of bone, hardware placement, and contrast studies.

Question 9: During a procedure, the surgeon requests an additional instrument that has not been sterilized. The correct response is to:

Flash sterilize it only if it will be used on intact tissue
Refuse to provide it until proper sterilization is complete (Correct answer)
Wipe it with a sterile towel and pass it to the surgeon
Soak it in high-level disinfectant for 2 minutes

Correct answer: Refuse to provide it until proper sterilization is complete

Instruments must be properly sterilized before use; no shortcuts are acceptable for items entering sterile tissue, regardless of urgency.

Question 10: What is the purpose of a sterility maintenance cover (dust cover) on sterile packages after sterilization?

To indicate the sterilization cycle used
To extend the sterilization date by 6 months
To re-sterilize the outer wrap after transport
To protect packaging from dust, moisture, and physical damage during storage (Correct answer)

Correct answer: To protect packaging from dust, moisture, and physical damage during storage

A sterility maintenance cover (dust cover) protects the sterile packaging from environmental contaminants and physical damage during storage and transport.

Question 11: Which of the following best describes the role of the surgical technologist during the preoperative phase when the patient is being transferred to the OR table?

Assisting with safe patient transfer and ensuring IV lines and tubes are protected (Correct answer)
Documenting the transfer in the electronic health record
Obtaining final consent signatures before transfer is complete
Observing from a distance to avoid contaminating the sterile field

Correct answer: Assisting with safe patient transfer and ensuring IV lines and tubes are protected

The surgical technologist actively assists with safe patient transfer, helping to protect IV lines, drains, and the airway while preventing patient falls.

Question 12: Which muscle relaxant is classified as a depolarizing neuromuscular blocking agent?

Vecuronium
Rocuronium
Succinylcholine (Correct answer)
Cisatracurium

Correct answer: Succinylcholine

Succinylcholine is the only clinically used depolarizing neuromuscular blocker, acting by mimicking acetylcholine and causing persistent depolarization.

Question 13: When preparing the OR for a morbidly obese patient (BMI > 40), which preoperative consideration is most important for positioning?

Obese patients are always placed in the Trendelenburg position for all procedures
A bariatric-rated OR table and appropriately sized positioning aids must be confirmed available (Correct answer)
The patient should be positioned in the prone position to distribute weight evenly
Standard OR tables and positioning aids are sufficient for all patients

Correct answer: A bariatric-rated OR table and appropriately sized positioning aids must be confirmed available

Bariatric patients require specially rated tables (typically ≥500 lb capacity) and wider positioning aids to prevent equipment failure and pressure injuries.

Question 14: The mitral valve separates which two cardiac chambers?

Left ventricle and aorta
Left atrium and left ventricle (Correct answer)
Right atrium and right ventricle
Right ventricle and pulmonary artery

Correct answer: Left atrium and left ventricle

The mitral (bicuspid) valve is located between the left atrium and left ventricle, preventing backflow during ventricular systole.

Question 15: A patient is given atropine sulfate preoperatively. What is the primary purpose of this medication in this context?

To induce sedation and amnesia
To provide postoperative pain relief
To reverse the effects of narcotics
To reduce oral and respiratory secretions (Correct answer)

Correct answer: To reduce oral and respiratory secretions

Atropine is an anticholinergic drug that blocks the action of acetylcholine. A primary preoperative use is to inhibit salivary and bronchial secretions (an antisialagogue effect), which helps maintain a clear airway during anesthesia. It also blocks vagal reflexes on the heart, which can prevent bradycardia.

Question 16: Which condition is characterized by hypotension, bronchospasm, and urticaria occurring after drug administration, requiring immediate epinephrine treatment?

Septic shock
Neuroleptic malignant syndrome
Malignant hyperthermia
Anaphylaxis (Correct answer)

Correct answer: Anaphylaxis

Anaphylaxis is a severe, life-threatening allergic reaction involving IgE-mediated mast cell degranulation, treated immediately with epinephrine 0.3–0.5 mg IM.

Question 17: What features of the PACU might promote the psychological health of a surgical patient?

There are numerous monitors, letting patients know that the PACU has cutting-edge equipment to support them.
Low lighting is used during recovery to protect the patient from bright glare. (Correct answer)
The presence of so many nurses and technicians inspires the patient's faith in the nursing staff's skills.
A spacious, open area in which the patient is aware that others are recovering from surgery as well.

Correct answer: Low lighting is used during recovery to protect the patient from bright glare.

Low lighting in the Post-Anesthesia Care Unit (PACU) helps create a calm and soothing environment for patients emerging from anesthesia. It reduces sensory overload, minimizes discomfort from bright glare, and can help prevent agitation or disorientation. This contributes significantly to the patient's psychological comfort and promotes a smoother recovery process.

Question 18: Postoperative ileus is best identified by:

Presence of active bowel sounds
Diarrhea and cramping
Rectal bleeding
Absence of bowel sounds and failure to pass flatus (Correct answer)

Correct answer: Absence of bowel sounds and failure to pass flatus

Postoperative ileus is a temporary cessation of bowel function characterized by absent bowel sounds, abdominal distension, and inability to pass gas or stool.

Question 19: A 'raytec' sponge is most commonly used in surgery to:

Cover and protect exposed organs
Blot small amounts of blood within the operative wound (Correct answer)
Pack large abdominal cavities
Wrap delicate instruments on the back table

Correct answer: Blot small amounts of blood within the operative wound

Raytec (4×4) sponges are small gauze sponges used for blotting and absorbing blood within the wound; they contain a radiopaque strip for detection if retained.

Question 20: The Universal Protocol for preventing wrong-site surgery was established by which organization?

The Joint Commission (Correct answer)
WHO
AORN
AST

Correct answer: The Joint Commission

The Joint Commission introduced the Universal Protocol in 2004 to prevent wrong-site, wrong-procedure, and wrong-person surgery.

Question 21: What is the recommended temperature range for storing sterile supplies to maintain package integrity?

78–85°F (26–29°C)
64–75°F (18–24°C) (Correct answer)
86–90°F (30–32°C)
50–60°F (10–15°C)

Correct answer: 64–75°F (18–24°C)

Sterile supplies should be stored between 64–75°F (18–24°C) to prevent condensation and packaging degradation.

Question 22: Which device is used to prevent a patient from sliding headward on the table during steep Trendelenburg positioning?

Kidney rest under the flank
Stirrups at the foot of the table
Padded shoulder braces or non-skid mattress pad (Correct answer)
Allen arm boards

Correct answer: Padded shoulder braces or non-skid mattress pad

Padded shoulder braces or non-skid foam mattresses prevent cephalad sliding while distributing force broadly across the shoulder girdle to minimize brachial plexus injury risk.

Question 23: Which preoperative action helps reduce the risk of hypothermia during surgery?

Removing all blankets to allow skin assessment before transfer
Applying a forced-air warming blanket in the preoperative area (Correct answer)
Lowering the OR temperature to 62°F before patient arrival
Administering IV fluids at room temperature throughout the case

Correct answer: Applying a forced-air warming blanket in the preoperative area

Pre-warming patients with forced-air warming blankets before surgery reduces the temperature gradient that causes core-to-peripheral heat redistribution after induction.

Question 24: The inner ear's spiral, conical structure is called the

Formalin
Third
Cochlea (Correct answer)
Penrose

Correct answer: Cochlea

The cochlea is the correct answer because it is the spiral-shaped, fluid-filled cavity in the inner ear responsible for converting sound vibrations into nerve impulses. This conical structure houses the organ of Corti, which contains the hair cells crucial for hearing, making it central to auditory perception.

Question 25: The scrub technologist notices the surgeon has perforated the bowel during dissection. The FIRST priority is to:

Document the incident in the operative record
Notify the circulator and contain contamination with wet sponges (Correct answer)
Change all instruments and drapes immediately
Immediately close the wound

Correct answer: Notify the circulator and contain contamination with wet sponges

Containing contamination by isolating the perforated bowel with wet sponges and alerting the circulator is the immediate priority to prevent further peritoneal soiling.

Question 26: Brachial plexus stretch injury in the supine position is most commonly caused by:

Arm tucked securely at the patient's side
Neutral head positioning
Arm abduction greater than 90 degrees (Correct answer)
Padding the elbow

Correct answer: Arm abduction greater than 90 degrees

Abducting the arm beyond 90 degrees on an arm board overstretches the brachial plexus between the clavicle and first rib, causing neuropraxia.

Question 27: What three elements does the surgical 'time-out' verify before incision?

Patient identity, correct site, and correct procedure (Correct answer)
Consent form, lab results, and imaging
Surgeon credentials, patient allergies, and blood type
Equipment sterilization, anesthesia dosage, and instrument count

Correct answer: Patient identity, correct site, and correct procedure

The time-out confirms the correct patient, correct surgical site, and correct procedure to prevent sentinel events before the incision is made.

Question 28: Which serious complication can result from prolonged prone positioning due to direct ocular pressure and reduced perfusion?

Postoperative visual loss (POVL) (Correct answer)
Lower extremity compartment syndrome
Brachial plexus neuropathy
Deep vein thrombosis

Correct answer: Postoperative visual loss (POVL)

Pressure on the globe combined with systemic hypotension can cause ischemic optic neuropathy, resulting in permanent postoperative visual loss.

Question 29: What is the correct order for surgical gowning when using the closed-glove technique?

Scrub hands after gowning before gloving
Glove first, then gown
Gown and glove simultaneously with assistance
Gown first, keeping hands inside sleeves, then glove (Correct answer)

Correct answer: Gown first, keeping hands inside sleeves, then glove

In the closed-glove technique, the gown is donned first with hands kept inside the sleeves, and gloves are then applied without exposing bare hands.

Question 30: A patient scheduled for a total knee arthroplasty asks if a tourniquet will be used. What is the surgical technologist's best response?

Tourniquets are never used in joint replacement surgeries
Tourniquets are required by law for all orthopedic procedures
That decision is made by the surgeon and you can ask them directly (Correct answer)
Inflating a tourniquet is not your responsibility to explain

Correct answer: That decision is made by the surgeon and you can ask them directly

Surgical technologists should direct clinical questions about surgical decisions to the surgeon, who will discuss tourniquet use as part of informed consent.

Question 31: Which one of the following constitutes a high-level disinfection technique?

Feet first, side rails up
2% glutaraldehyde for 20 minutes (Correct answer)
Acromioclavicular joint to iliac crest
Name, Date of birth, Physician

Correct answer: 2% glutaraldehyde for 20 minutes

High-level disinfection is a process that kills all microorganisms except for a high number of bacterial spores. Using 2% glutaraldehyde for 20 minutes is a recognized method for achieving high-level disinfection, as glutaraldehyde is a potent chemical sterilant and disinfectant effective against a broad spectrum of microbes. This method is commonly used for heat-sensitive medical devices that cannot be sterilized by heat.

Question 32: During the preoperative time-out, a discrepancy is noted between the surgical consent and the procedure listed on the OR schedule. What should occur?

Rely on the surgeon's verbal confirmation and continue
Stop and resolve the discrepancy before the procedure begins (Correct answer)
Proceed using the OR schedule as it is the most current document
Ask the scrub tech to initial the consent form as corrected

Correct answer: Stop and resolve the discrepancy before the procedure begins

Any discrepancy identified during the time-out must halt the procedure until the correct information is verified and all team members agree before incision.

Question 33: Which of the following glands may have irritation if the mumps is present?

270-276
Third
Hysterectomy
Parotid (Correct answer)

Correct answer: Parotid

The correct answer is the Parotid gland. Mumps is a viral infection primarily known for causing painful swelling of the parotid glands, which are the largest salivary glands located just below and in front of the ears. This characteristic swelling is a hallmark symptom of the disease.

Question 34: Which opioid analgesic is most commonly administered intraoperatively as a continuous infusion due to its rapid onset and titrability?

Meperidine
Morphine
Codeine
Remifentanil (Correct answer)

Correct answer: Remifentanil

Remifentanil has an ultra-short half-life due to ester hydrolysis, making it ideal for intraoperative infusion with rapid offset upon discontinuation.

Question 35: Which of the following packaging materials is NOT acceptable for steam sterilization?

Nonwoven polypropylene wraps
Woven muslin wraps
Sterilization pouches with paper-plastic sides
Aluminum foil (Correct answer)

Correct answer: Aluminum foil

Aluminum foil does not allow steam penetration and is not acceptable for steam sterilization.

Question 36: The purpose of a 'cold light' fiber-optic light source in endoscopy is to:

Monitor temperature inside the body cavity
Illuminate the surgical field without generating heat at the tip (Correct answer)
Power the insufflation system
Sterilize the endoscope during use

Correct answer: Illuminate the surgical field without generating heat at the tip

Fiber-optic 'cold light' sources transmit light to the endoscope tip without conducting heat, preventing tissue burns inside body cavities.

Question 37: Which respiratory complication is associated with the Trendelenburg position?

No significant respiratory changes
Increased tidal volume from diaphragm descent
Improved alveolar ventilation due to gravity
Decreased lung compliance and atelectasis from cephalad organ displacement (Correct answer)

Correct answer: Decreased lung compliance and atelectasis from cephalad organ displacement

In Trendelenburg, abdominal viscera press cephalad against the diaphragm, reducing functional residual capacity and lung compliance, increasing atelectasis risk.

Question 38: The modern concept of 'event-related sterility' dictates that an item remains sterile until what occurs?

The expiration date printed on the package is reached.
The item is moved from central sterile supply to the operating room.
An event compromises the integrity of the package. (Correct answer)
The item has been stored for more than 30 days in a clean, dry area.

Correct answer: An event compromises the integrity of the package.

Event-related sterility (ERS) is the current standard, replacing time-related expiration dates. It posits that a product remains sterile until an 'event' occurs that compromises the package barrier. Such events include tears, punctures, moisture penetration, or broken seals, regardless of how long the item has been sterilized.

Question 39: A needle holder with scissors incorporated into the jaws is known as a:

Olsen-Hegar needle holder (Correct answer)
Webster needle holder
Mayo-Hegar needle holder
Castroviejo needle holder

Correct answer: Olsen-Hegar needle holder

The Olsen-Hegar needle holder has scissors built into the jaws, allowing the surgeon to suture and cut in one instrument without switching tools.

Question 40: A patient undergoing cardiac surgery requires placement of a Foley catheter. When should this catheter ideally be inserted?

After the first incision is made and the surgical field is established
In the preoperative holding area before the patient is transported to the OR
Only if the patient cannot void spontaneously postoperatively
After the patient is intubated and positioned on the OR table (Correct answer)

Correct answer: After the patient is intubated and positioned on the OR table

Foley catheters for major surgery are typically inserted after anesthesia induction to maximize patient comfort and reduce anxiety during the procedure.

Question 41: A patient with a BMI of 30 is admitted for surgery. What potential difficulties during the surgical procedure can be brought on by obesity?

Anemia is more likely to develop in the patient
An infection is more prone to spread to the patient (Correct answer)
Postoperative bleeding is more likely to occur in the patient
Diarrhea is more likely to strike the sufferer

Correct answer: An infection is more prone to spread to the patient

Obesity significantly increases the risk of surgical site infections (SSIs) due to several factors. Adipose tissue has poor vascularity, which impairs oxygen delivery and antibiotic penetration to the surgical site, hindering healing and immune response. Additionally, larger incisions, increased tension on wound edges, and difficulty maintaining sterile fields can contribute to a higher susceptibility to infection in obese patients.

Question 42: What does a Class 5 chemical integrator (integrating indicator) confirm when found acceptable after sterilization?

That biological indicators are negative
That all critical sterilization parameters were met (Correct answer)
That the package was properly sealed
Only that the correct temperature was reached

Correct answer: That all critical sterilization parameters were met

Class 5 integrating indicators respond to all critical sterilization parameters (time, temperature, and steam) to confirm acceptable conditions.

Question 43: What position is typically used for hemorrhoidectomy?

Supine
Jack-knife (Correct answer)
Knee-chest
Lateral

Correct answer: Jack-knife

The jack-knife position, also known as Kraske position, is typically used for hemorrhoidectomy procedures. In this position, the patient lies prone with the hips flexed and the head and feet lowered, creating an inverted V-shape. This positioning provides optimal exposure of the perianal and rectal area, facilitating surgical access for the removal of hemorrhoids.

Question 44: Why does central processing send a case cart with operating room materials for a surgical procedure?

It saves time for the nursing team in deciding what supplies are required.
It enables the central processing unit to decide which materials are required for each distinct procedure.
It leaves more space in the operating room for the surgery by reducing the number of supplies and materials there. (Correct answer)
It adds to the workload of those working in central processing.

Correct answer: It leaves more space in the operating room for the surgery by reducing the number of supplies and materials there.

A case cart system is designed to deliver all necessary sterile supplies and instruments for a specific surgical procedure to the operating room (OR) in an organized manner. By pre-assembling and delivering only the required items, it minimizes clutter and reduces the overall volume of supplies stored within the OR itself. This optimization of space enhances efficiency, safety, and workflow during the surgical procedure.

Question 45: Before a colon resection, the nurse assesses a patient and finds that their blood pressure is excessive at 142/90 mmHg. The nurse should do what comes next, right?

Tell the patient they must lie flat for the next hour while you lower the bed's head
Obtain a prescription for antihypertensive drugs to maintain a healthy blood pressure level
Report the blood pressure reading to the doctor and consider rescheduling the surgery
Please note the vital sign in the patient's chart, let them rest peacefully in a room, and then check again in 30 minutes (Correct answer)

Correct answer: Please note the vital sign in the patient's chart, let them rest peacefully in a room, and then check again in 30 minutes

A blood pressure reading of 142/90 mmHg, while slightly elevated, is not an immediate contraindication for surgery unless accompanied by other severe symptoms or a history of uncontrolled hypertension. The appropriate nursing action is to document the finding, allow the patient to rest, and recheck the blood pressure after 30 minutes. This allows for potential reduction due to pre-operative anxiety and provides a more accurate baseline before escalating concerns to the physician.

Question 46: During a cesarean section, the scrub tech should anticipate having a bulb syringe available primarily to:

Clear the neonate's airway of fluid immediately after delivery (Correct answer)
Irrigate the uterine cavity after placental delivery
Aspirate amniotic fluid from the operative field
Inject local anesthetic into the uterine incision

Correct answer: Clear the neonate's airway of fluid immediately after delivery

A bulb syringe is used to suction mucus and amniotic fluid from the neonate's mouth and nose immediately after delivery to facilitate breathing.

Question 47: A patient is scheduled for a left knee arthroscopy. According to the Universal Protocol, which action is most critical for preventing wrong-site surgery?

Confirming the procedure with the circulating nurse.
Reviewing the patient's imaging studies in the operating room.
Marking the operative site with an indelible marker before the patient is sedated. (Correct answer)
Verifying the patient's name and date of birth.

Correct answer: Marking the operative site with an indelible marker before the patient is sedated.

The Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery requires marking the operative site. This mark should be made by the person performing the procedure, involve the patient while they are awake and aware, and be visible after prepping and draping. While all other steps are important parts of the verification process, the physical marking of the site is a key preventative measure.

Question 48: What effects do antagonistic medications have?

acromioclavicular joint to iliac crest
upper arms, neckline and axillary region
repositioning penetrating towel clip
counteract the action of another drug (Correct answer)

Correct answer: counteract the action of another drug

Antagonistic medications are drugs that bind to a receptor but do not activate it. Instead, they block or reduce the effect of another drug or a natural substance that would normally activate that receptor. This action effectively counteracts or opposes the physiological or pharmacological effects of other agents.

Question 49: Which of the following is the electrosurgical unit's active electrode?

Pencil (Correct answer)
Wall plug
Voltage intensity dial
Grounding pad

Correct answer: Pencil

In electrosurgery, the active electrode is the component that delivers the high-frequency electrical current directly to the patient's tissue for cutting or coagulation. The electrosurgical pencil, held by the surgeon, contains the active electrode tip. The grounding pad, in contrast, is the dispersive electrode that safely returns the current to the unit.

Question 50: When opening a peel pouch onto the sterile field, the circulator should:

Peel the sides apart and drop contents without touching the inner surface (Correct answer)
Hand the pouch to the scrub to open
Tear the pouch from the sealed end toward the opening
Flip the pouch upside down over the field

Correct answer: Peel the sides apart and drop contents without touching the inner surface

The circulator peels the pouch sides apart and drops the contents onto the sterile field without touching the inner sterile surface.

Question 51: Which retractor is commonly used to retract the liver during upper abdominal procedures?

Harrington retractor (Correct answer)
Weinberg retractor
Balfour retractor
O'Sullivan-O'Connor retractor

Correct answer: Harrington retractor

The Harrington (sweetheart) retractor has a broad paddle shape specifically designed to retract the liver safely during upper abdominal surgery.

Question 52: Surgical site marking should be performed by:

The circulating nurse on admission
The scrub technologist at setup
The anesthesiologist during induction
The operating surgeon before the procedure (Correct answer)

Correct answer: The operating surgeon before the procedure

The performing surgeon is responsible for marking the operative site before the procedure, ideally with patient involvement while the patient is awake.

Question 53: How should soiled sponges be organized in the kick bucket to facilitate accurate counting?

Tossed in loosely for speed
Placed in groups of 3 or 6
Kept in groups of 5 or 10 (Correct answer)
Separated individually and spread on the floor

Correct answer: Kept in groups of 5 or 10

Soiled sponges are kept in groups of 5 or 10 in the kick bucket so they can be quickly and accurately recounted during closing counts.

Question 54: When using the Bovie electrosurgical unit, the dispersive electrode (grounding pad) should be placed:

Over a bony prominence close to the operative site
On the patient's back regardless of surgical site
On a well-vascularized muscle mass as close to the operative site as possible (Correct answer)
Over scar tissue for better adhesion

Correct answer: On a well-vascularized muscle mass as close to the operative site as possible

The dispersive electrode must be placed on a well-vascularized muscle mass close to the operative site to ensure safe current return and prevent burns.

Question 55: What bodily part undergoes preparation for an ORIF of the humerus?

Leg, foot to hip
Arm, fingers to shoulder (Correct answer)
Arm, fingers to elbow
Arm, foot to shoulder

Correct answer: Arm, fingers to shoulder

For an Open Reduction Internal Fixation (ORIF) of the humerus, the surgical preparation area must encompass the entire arm, extending from the fingertips up to the shoulder. This wide prep area ensures that the surgical team has sterile access to the entire bone and surrounding tissues, accommodating potential extensions of the incision or manipulation of the limb during the procedure. It also accounts for any necessary draping and movement of the arm.

Question 56: What is the purpose of the 'time-out' performed immediately before a surgical incision?

To confirm all instruments have been counted
To allow the surgeon to review imaging
To allow the anesthesiologist to administer the final drug dose
To verify patient identity, procedure, site, and antibiotic administration (Correct answer)

Correct answer: To verify patient identity, procedure, site, and antibiotic administration

The surgical time-out is a WHO safety checklist step that actively confirms correct patient, correct procedure, correct site, and antibiotic prophylaxis before incision.

Question 57: During a laparoscopic cholecystectomy, the 'critical view of safety' requires identification of the cystic duct and which other structure?

Common bile duct
Right hepatic artery
Cystic artery (Correct answer)
Common hepatic duct

Correct answer: Cystic artery

The critical view of safety requires that only the cystic duct and cystic artery are seen entering the gallbladder, preventing misidentification of the common bile duct.

Question 58: Raytec (X-ray detectable) sponges are used intraoperatively rather than standard gauze because:

They are more absorbent than regular gauze
They can be identified on postoperative X-ray if accidentally retained (Correct answer)
They are less likely to adhere to delicate tissue
They are cheaper and more readily available

Correct answer: They can be identified on postoperative X-ray if accidentally retained

Raytec sponges contain a radiopaque filament detectable on X-ray, which allows identification of any retained sponge during postoperative imaging.

Question 59: Which instrument is used to grasp and hold tissue during surgery without crushing it?

Kocher clamp
Kelly clamp
Babcock forceps (Correct answer)
Rochester-Pean forceps

Correct answer: Babcock forceps

Babcock forceps have atraumatic, non-toothed jaws designed to grasp delicate structures like the bowel without crushing.

Question 60: Which surgical position is most commonly used for procedures on the spine, buttocks, and posterior lower extremities?

Lateral (lateral decubitus)
Fowler's (sitting)
Supine
Prone (Correct answer)

Correct answer: Prone

The prone position places the patient face-down, providing optimal access to the posterior surfaces of the body for spinal and dorsal procedures.

Question 61: When using ethylene oxide (EO) sterilization, why is an aeration period required after the cycle?

To dissipate toxic EO residues before the item is safe for patient contact (Correct answer)
To complete the chemical indicator color change
To allow the items to cool to room temperature before handling
To rehydrate moisture-sensitive items

Correct answer: To dissipate toxic EO residues before the item is safe for patient contact

EO gas is toxic; aeration is mandatory to allow residual EO and its byproducts to dissipate to safe levels before items contact patients.

Question 62: Which of the following provides the most definitive evidence that a sterilization cycle was effective?

A biological indicator containing Geobacillus stearothermophilus spores shows no growth after incubation. (Correct answer)
The indicator tape on the outside of the package has changed color.
The printout from the sterilizer shows all physical parameters were met.
A chemical indicator strip inside the pack has changed to the correct color.

Correct answer: A biological indicator containing Geobacillus stearothermophilus spores shows no growth after incubation.

A biological indicator (BI) is the gold standard for verifying sterilization efficacy. It directly challenges the sterilizer's ability to kill the most resistant microorganisms, such as Geobacillus stearothermophilus spores for steam sterilizers. A negative result (no growth) provides the highest level of assurance that the sterilization process was lethal. Chemical indicators and physical readouts only confirm that the items were exposed to certain conditions, not that sterility was achieved.

Question 63: The WHO Surgical Safety Checklist is divided into how many phases?

Two
Five
Four
Three (Correct answer)

Correct answer: Three

The WHO checklist has three phases: Sign In (before anesthesia), Time Out (before incision), and Sign Out (before patient leaves OR).

Question 64: X-ray detectable sponges are used in surgery primarily to:

Absorb larger volumes of blood
Reduce the risk of wound infection
Speed up the counting process
Enable radiographic detection if inadvertently retained (Correct answer)

Correct answer: Enable radiographic detection if inadvertently retained

Radiopaque markers woven into surgical sponges allow them to be identified on X-ray if a retained item is suspected.

Question 65: During preoperative patient identification, which of the following methods is considered the most reliable practice according to WHO guidelines?

Using at least two patient identifiers, such as name and date of birth. (Correct answer)
Asking the patient, "Are you John Smith?"
Checking the patient's room number against the surgical schedule.
Matching the patient's appearance to their chart photograph.

Correct answer: Using at least two patient identifiers, such as name and date of birth.

The World Health Organization (WHO) and other patient safety organizations recommend using at least two patient identifiers to verify a patient's identity before any procedure. This should involve asking the patient to state their full name and date of birth. Using the room number is unreliable, and asking a yes/no question is not as safe as having the patient state the information themselves.

Question 66: Which of the following is the strongest against sterilizing techniques?

Spore (Correct answer)
Spirochete
Virus
Tubercle bacillus

Correct answer: Spore

Bacterial spores are the most resistant forms of microbial life to sterilization techniques. These dormant, highly resilient structures are formed by certain bacteria, like *Clostridium* and *Bacillus*, to survive harsh environmental conditions. Their tough outer coat and dehydrated core make them extremely difficult to destroy with heat, chemicals, or radiation, requiring more rigorous sterilization methods like steam under pressure (autoclaving).

Question 67: Which medication class is used preoperatively to reduce gastric acidity and decrease risk of aspiration pneumonitis?

Beta blockers
Alpha-2 agonists
Calcium channel blockers
H2-receptor antagonists (Correct answer)

Correct answer: H2-receptor antagonists

H2-receptor antagonists such as ranitidine reduce gastric acid secretion, decreasing risk and severity of aspiration pneumonitis.

Question 68: How many times are surgical counts typically performed during a standard operative procedure?

Three to four times — initial, before cavity closure, and at skin closure (Correct answer)
Once, at the start
Five times throughout the case
Twice — start and end

Correct answer: Three to four times — initial, before cavity closure, and at skin closure

Counts are performed at initial setup, before closure of a body cavity, before skin closure, and at case end to ensure no items are retained.

Question 69: Which suture needle point is most appropriate for suturing delicate vascular tissue?

Reverse cutting needle
Taper needle (Correct answer)
Cutting needle
Blunt needle

Correct answer: Taper needle

Taper (round) needles are used for vascular tissue because they push tissue aside rather than cutting, reducing the risk of vessel tearing.

Question 70: During instrumentation setup, instruments should be organized on the back table according to:

Alphabetical order by instrument name
Manufacturer's catalog number
The order of use during the procedure (Correct answer)
Size from largest to smallest

Correct answer: The order of use during the procedure

Instruments are arranged on the back table in the order they will be used during the procedure to allow efficient, rapid passing without searching.

Question 71: What is the minimum recommended distance a non-sterile person should maintain from a sterile field?

18 inches (Correct answer)
24 inches
12 inches
6 inches

Correct answer: 18 inches

Non-sterile personnel must maintain at least an 18-inch margin from a sterile field to prevent contamination.

Question 72: What one of the following is invasive hemodynamic monitoring used for during surgery?

Both A and C
To assess for depletion or restoration of electrolytes.
To measure effectiveness of the heart muscle. (Correct answer)
To confirm changes in the patient’s clinical status.

Correct answer: To measure effectiveness of the heart muscle.

Invasive hemodynamic monitoring involves placing catheters into blood vessels and the heart to directly measure pressures, volumes, and cardiac output. These measurements provide real-time, precise data on the heart's pumping ability and overall cardiovascular function. This allows clinicians to assess the effectiveness of the heart muscle and guide interventions during surgery.

Question 73: When donning a sterile gown and gloves using the closed-gloving technique, which part of the gown is considered non-sterile?

The front of the gown from chest to the level of the sterile field.
The back of the gown and the stockinette cuffs. (Correct answer)
The entire outer surface of the gown once it is tied.
The sleeves from 2 inches above the elbow to the cuff.

Correct answer: The back of the gown and the stockinette cuffs.

The back of the surgical gown is considered non-sterile because it cannot be continuously monitored by the wearer and may brush against unsterile surfaces. The stockinette cuffs are also considered non-sterile as they are designed to be enclosed within the glove, and the wearer's hands pass through them, making them prone to contamination.

Question 74: Which of the following is the PRIMARY responsibility of the surgical technologist regarding the surgical consent form?

Obtaining the patient's signature on the form.
Determining if the patient is mentally competent to sign the consent.
Explaining the risks and benefits of the procedure to the patient.
Verifying that the signed consent form is in the patient's chart before the procedure begins. (Correct answer)

Correct answer: Verifying that the signed consent form is in the patient's chart before the procedure begins.

While the surgeon is responsible for explaining the procedure and obtaining consent, the surgical technologist, as part of the entire surgical team, must verify that a valid and signed consent form is present in the patient's medical record before the surgery starts. This is a critical step in the preoperative verification process.

Question 75: The electrosurgical unit (ESU) dispersive electrode should be placed:

Over a bony prominence
Over a scar or skin lesion
On the patient's back near the spine
On a large muscle mass close to the operative site (Correct answer)

Correct answer: On a large muscle mass close to the operative site

The dispersive electrode should be placed on a large, well-vascularized muscle mass near the operative site to ensure safe current return.

Question 76: The primary advantage of monofilament sutures over braided (multifilament) sutures is:

Greater tensile strength and knot security
Less tissue drag and reduced risk of harboring infection (Correct answer)
Easier handling and tying
Longer absorption time

Correct answer: Less tissue drag and reduced risk of harboring infection

Monofilament sutures have a smooth surface that produces less tissue drag and fewer interstices where bacteria can colonize, lowering infection risk.

Question 77: When preparing a patient's skin for surgery, which of the following is the primary goal of the preoperative skin prep?

To reduce the number of microorganisms on the skin to an irreducible minimum. (Correct answer)
To sterilize the patient's skin.
To remove all resident and transient flora.
To remove hair from the surgical site.

Correct answer: To reduce the number of microorganisms on the skin to an irreducible minimum.

The primary goal of preoperative skin antisepsis is to remove soil and transient microorganisms and to reduce the resident microbial count to the lowest possible level, thereby reducing the risk of a surgical site infection (SSI). It is not possible to completely sterilize the skin, as some resident flora will always remain.

Question 78: What is the standard biological indicator organism used to verify steam autoclave sterilization efficacy?

Bacillus subtilis
Staphylococcus aureus
Geobacillus stearothermophilus (Correct answer)
Clostridium sporogenes

Correct answer: Geobacillus stearothermophilus

Geobacillus stearothermophilus spores are the standard biological indicator for steam sterilization because of their high heat resistance.

Question 79: A surgical technologist is preparing powered instruments, such as a drill and saw, for decontamination after an orthopedic procedure. What is the MOST critical first step according to standard guidelines?

Place the entire assembly in an ultrasonic cleaner to loosen bioburden.
Disassemble the components and wipe them down, keeping the power unit/cable connections dry. (Correct answer)
Immerse the handpiece and attachments in an enzymatic soak.
Send the assembled instruments directly to central sterile processing without pre-cleaning.

Correct answer: Disassemble the components and wipe them down, keeping the power unit/cable connections dry.

Powered surgical instruments cannot be fully submerged due to their electrical components. The correct initial step is to follow the manufacturer's Instructions for Use (IFU), which typically involves disassembling the device, wiping down the exterior, and manually cleaning attachments, while ensuring the power unit, cable, and battery housing remain dry to prevent damage. [31, 26]

Question 80: If an ovarian tumor is cancerous, what organs must be removed?

Bilateral fallopian tubes and ovaries, uterus (Correct answer)
Never until the patient is discharged from the facility
Patient marks with an “X” and witness verify
Upper arms, neckline and axillary region

Correct answer: Bilateral fallopian tubes and ovaries, uterus

When an ovarian tumor is cancerous, the standard surgical treatment often involves a total hysterectomy with bilateral salpingo-oophorectomy. This procedure removes the uterus, both fallopian tubes, and both ovaries. This comprehensive removal ensures all potential cancerous tissue and areas of metastasis are excised, as ovarian cancer can spread locally to these adjacent organs.

Question 81: Reverse Trendelenburg position (head up, feet down) is most beneficial for which type of surgery?

Pelvic laparoscopy
Hip replacement
Sacral cyst excision
Laparoscopic cholecystectomy and upper abdominal procedures (Correct answer)

Correct answer: Laparoscopic cholecystectomy and upper abdominal procedures

Reverse Trendelenburg allows gravity to displace abdominal viscera away from the upper abdomen, improving visualization during cholecystectomy and esophageal procedures.

Question 82: Which structure is the landmark for the femoral triangle and lies between the femoral artery and the femoral canal?

Great saphenous vein
Profunda femoris artery
Femoral vein (Correct answer)
Femoral nerve

Correct answer: Femoral vein

In the femoral triangle, the arrangement from lateral to medial is: femoral Nerve, femoral Artery, femoral Vein, empty space/canal (NAVY).

Question 83: Which instrument is used to grasp and manipulate the intestine without crushing the tissue?

Ochsner clamp
Kocher clamp
Allis forceps
Babcock forceps (Correct answer)

Correct answer: Babcock forceps

Babcock forceps have a fenestrated, atraumatic tip designed to grasp delicate structures like the bowel without crushing them.

Question 84: Which surgical position places the patient flat on their back with arms either tucked or extended on arm boards?

Lithotomy
Lateral
Supine (Correct answer)
Prone

Correct answer: Supine

The supine position has the patient lying flat on their back and is the most commonly used position for anterior abdominal, thoracic, and extremity surgeries.

Question 85: In OR fire prevention, the 'fire triangle' consists of an ignition source, an oxidizer, and:

A flammable drape
Electrosurgical unit
Fuel (Correct answer)
Oxygen tubing

Correct answer: Fuel

The fire triangle requires an ignition source (ESU, laser), an oxidizer (O₂, N₂O), and a fuel (drapes, alcohol preps, patient hair) — removing any one element prevents fire.

Question 86: What is the preferred position for breast surgery?

Lithotomy
Lateral
Dorsal Recumbent (Correct answer)
Prone

Correct answer: Dorsal Recumbent

The dorsal recumbent position, where the patient lies flat on their back, is the preferred position for most breast surgeries. This position allows for optimal exposure of the breast and axillary (underarm) regions. It also provides comfort for the patient and facilitates the surgeon's access to the surgical site.

Question 87: The rotator cuff is composed of four muscles. Which rotator cuff muscle is most commonly torn?

Supraspinatus (Correct answer)
Subscapularis
Teres minor
Infraspinatus

Correct answer: Supraspinatus

The supraspinatus tendon is the most commonly torn rotator cuff muscle because it passes through the narrow subacromial space and is subject to impingement.

Question 88: Which anesthesia type allows the patient to remain conscious while a specific body region is numbed?

Inhalation anesthesia
Regional anesthesia (Correct answer)
Moderate sedation
General anesthesia

Correct answer: Regional anesthesia

Regional anesthesia blocks nerve conduction in a specific area, allowing surgery while the patient remains awake or lightly sedated.

Question 89: What is the minimum internal temperature required for steam sterilization in a standard gravity displacement sterilizer?

270°F (132°C)
212°F (100°C)
285°F (141°C)
250°F (121°C) (Correct answer)

Correct answer: 250°F (121°C)

Gravity displacement steam sterilizers operate at a minimum of 250°F (121°C), held for at least 30 minutes for wrapped instruments.

Question 90: Which bony prominences must be padded to prevent pressure injuries during all surgical positions?

Heels only
Sacrum only
Elbows only
All bony prominences including heels, sacrum, elbows, and occiput (Correct answer)

Correct answer: All bony prominences including heels, sacrum, elbows, and occiput

All bony prominences with minimal overlying soft tissue are susceptible to ischemic pressure injury during prolonged immobility on the OR table.

Question 91: Which sterilization method is most appropriate for heat-sensitive instruments such as fiber-optic scopes?

Steam autoclave at 270°F
Ethylene oxide (EO) gas (Correct answer)
Dry heat oven
Flash sterilization at 132°C

Correct answer: Ethylene oxide (EO) gas

Ethylene oxide gas sterilizes at low temperatures, making it safe for heat-sensitive items like endoscopes and fiber-optic instruments.

Question 92: Which closure technique describes suturing the wound in discrete individual loops, each tied separately?

Interrupted suture (Correct answer)
Running (continuous) suture
Purse-string suture
Figure-of-eight suture

Correct answer: Interrupted suture

Interrupted sutures are placed as separate loops; if one suture fails, the others maintain wound integrity — preferred in infected or high-risk wounds.

Question 93: Which of the following correctly describes the concept of 'event-related sterility'?

Sterility depends on the temperature of the storage room at all times
Sterility expires after a fixed time period regardless of storage conditions
Sterility is maintained until the package is opened or integrity is compromised by an event (Correct answer)
Sterility is guaranteed only if chemical indicators are within date

Correct answer: Sterility is maintained until the package is opened or integrity is compromised by an event

Event-related sterility means a package remains sterile until an event (tear, moisture, opening) compromises packaging integrity, not simply based on a fixed expiration date.

Question 94: A 'never event' in perioperative care is best described as:

An unexpected intraoperative finding
A serious, largely preventable adverse event that should never occur (Correct answer)
An anaphylactic reaction to anesthesia
A rare but acceptable surgical complication

Correct answer: A serious, largely preventable adverse event that should never occur

Never events are serious, preventable patient safety incidents — such as retained surgical items or wrong-site surgery — that should be eliminated with proper protocols.

Question 95: Which combination of vital sign changes is the classic early indicator of postoperative hemorrhage?

Hypertension and tachycardia
Hypertension and bradycardia
Hypotension and tachycardia (Correct answer)
Hyperthermia and bradycardia

Correct answer: Hypotension and tachycardia

Postoperative hemorrhage causes decreased circulating volume, leading to hypotension and compensatory tachycardia as the body tries to maintain cardiac output.

Question 96: A Penrose drain operates by which mechanism?

Negative pressure from a bulb reservoir
Active suction from a wall unit
Positive pressure instillation
Passive gravity and capillary action (Correct answer)

Correct answer: Passive gravity and capillary action

A Penrose drain is a soft rubber tube that uses passive gravity and capillary action to allow fluid to drain from the wound — no suction device is needed.

Question 97: When draping a patient, the surgical technologist should unfold and place drapes in which direction?

From the far side of the patient inward toward the incision site
In any order as long as coverage is complete before the surgeon begins
From head to foot starting at the incision site
From the operative site outward toward the periphery (Correct answer)

Correct answer: From the operative site outward toward the periphery

Drapes are placed from the clean (operative site) outward toward the less-clean periphery to prevent contamination of the incision area.

Question 98: A surgical technologist is preparing for a case involving heat-sensitive instruments, such as flexible endoscopes. Which sterilization method would be most appropriate for these items?

Ionizing radiation
Steam autoclave
Dry heat sterilization
Ethylene Oxide (ETO) gas (Correct answer)

Correct answer: Ethylene Oxide (ETO) gas

Ethylene Oxide (ETO) is a low-temperature sterilization method suitable for items that are sensitive to heat and moisture, such as flexible scopes, plastics, and delicate instruments. Steam autoclaving and dry heat use high temperatures that would damage such items, while ionizing radiation is typically used for industrial sterilization of pre-packaged goods.

Question 99: The celiac trunk is the first major branch of the abdominal aorta and supplies blood to which organs?

Small and large intestine
Kidneys and adrenal glands
Bladder and rectum
Stomach, liver, and spleen (Correct answer)

Correct answer: Stomach, liver, and spleen

The celiac trunk branches into the left gastric, splenic, and common hepatic arteries, supplying the stomach, liver, and spleen.

Question 100: During a preoperative checkup, the nurse uses a tongue depressor to depress and move the patient's tongue. Which cranial nerve is being examined by this test?

VII (facial)
V (trigeminal)
XII (hypoglossal) (Correct answer)
X (Vagus)

Correct answer: XII (hypoglossal)

The hypoglossal nerve (cranial nerve XII) is primarily responsible for the motor control of the intrinsic and extrinsic muscles of the tongue. Depressing and moving the tongue with a tongue depressor directly assesses the function of these muscles. This test evaluates the integrity of the hypoglossal nerve, as damage can impair tongue movement, speech, and swallowing.

Question 101: The Bowie-Dick test is performed to verify that a sterilizer:

Maintains correct temperature throughout the full cycle
Is free of air pockets that impede steam penetration (Correct answer)
Has functioning mechanical gauges and printouts
Has reached the correct biological kill time

Correct answer: Is free of air pockets that impede steam penetration

The Bowie-Dick test specifically verifies that the pre-vacuum sterilizer adequately removes air, allowing uniform steam penetration.

Question 102: What position is typically used for hemorrhoidectomy?

Lateral
Supine
Jack-knife (Correct answer)
Knee-chest

Correct answer: Jack-knife

The jack-knife position, also known as the Kraske position, is typically used for hemorrhoidectomy. In this position, the patient lies prone (on their stomach) with their hips flexed and the buttocks elevated. This provides excellent exposure of the perianal area, allowing the surgeon clear access to the hemorrhoids.

Question 103: A sterile surgical technologist reaches across an unsterile area to retrieve an instrument. This action is:

Acceptable if the movement is quick
Allowed if wearing double gloves
Permitted when instruments are wrapped
A break in sterile technique (Correct answer)

Correct answer: A break in sterile technique

Reaching across an unsterile area risks contamination of the sterile gown and gloves, constituting a break in sterile technique.

Question 104: What pathology in neurosurgery would a myelogram identify?

cottingham punch
cancer procedures.
spinal stenosis (Correct answer)
10 minutes

Correct answer: spinal stenosis

A myelogram is a diagnostic imaging procedure that involves injecting a contrast dye into the spinal canal to visualize the spinal cord, nerve roots, and surrounding structures. This technique is highly effective in identifying conditions that compress the spinal cord or nerve roots, such as spinal stenosis, herniated discs, or tumors, by highlighting abnormalities in the spinal canal.

Question 105: When passing a scalpel to the surgeon, the surgical technologist should:

Hand it handle-first with the blade facing upward
Pass it blade-first so the surgeon can grasp the handle
Announce 'blade' and hand it directly blade-down
Place it in a neutral zone (basin or pad) to avoid direct hand-to-hand transfer (Correct answer)

Correct answer: Place it in a neutral zone (basin or pad) to avoid direct hand-to-hand transfer

AORN recommends using a neutral zone (hands-free technique) when passing sharp instruments to reduce sharps injuries.

Question 106: Which document is used to officially record surgical counts during an operative case?

Discharge summary
Count sheet / count record (Correct answer)
Operative report
Anesthesia record

Correct answer: Count sheet / count record

The count sheet (or count record) documents all items counted, who performed the count, and the results at each counting interval.

Question 107: A patient's preoperative blood pressure reads 188/110 mmHg. What is the most appropriate action?

Administer an antihypertensive from the crash cart
Document the reading and assume it is white-coat hypertension
Notify the anesthesia provider and surgeon before proceeding (Correct answer)
Transport the patient to the OR immediately to avoid further delay

Correct answer: Notify the anesthesia provider and surgeon before proceeding

Severely elevated blood pressure must be reported to the surgical team because it increases anesthetic and intraoperative bleeding risk and may require intervention before surgery.

Question 108: Which bone forms the posterior wall of the orbit and is commonly fractured in a 'blowout' orbital fracture?

Zygomatic bone
Ethmoid bone
Frontal bone
Orbital floor (maxilla) (Correct answer)

Correct answer: Orbital floor (maxilla)

A blowout fracture typically involves the thin orbital floor formed by the maxilla, which buckles inward under sudden increased intraorbital pressure.

Question 109: What is the correct sequence for applying antimicrobial skin prep to a surgical site?

From the periphery toward the incision site
Randomly across the entire field for complete coverage
From inferior to superior regardless of incision location
From the incision site outward in a circular motion (Correct answer)

Correct answer: From the incision site outward in a circular motion

Skin prep is applied from the cleanest area (incision site) outward to the periphery to prevent dragging microorganisms toward the surgical site.

Question 110: A patient scheduled for abdominal surgery reports taking warfarin daily. What is the most critical preoperative action?

Administer vitamin K without a physician order
Notify the surgeon and anesthesia provider immediately (Correct answer)
Double the patient's dose to prevent clotting during surgery
Proceed without changes as warfarin is safe perioperatively

Correct answer: Notify the surgeon and anesthesia provider immediately

Warfarin significantly increases bleeding risk, so the surgeon and anesthesia team must be notified to manage anticoagulation appropriately before surgery.

Question 111: For a patient in the lithotomy position, which of the following is a suitable placement area for the electrosurgical ground pad?

Posterior shoulder
Upper buttock
Upper arm
Anterior thigh (Correct answer)

Correct answer: Anterior thigh

For a patient in the lithotomy position, a suitable placement area for the electrosurgical ground pad (dispersive electrode) is the anterior thigh. This area provides a large, well-vascularized, and relatively flat surface for optimal contact, ensuring safe current dispersion and minimizing the risk of burns. The ground pad should be placed on a clean, dry, and hairless area, away from bony prominences or scar tissue.

Question 112: During a thyroidectomy, the recurrent laryngeal nerve must be identified. Damage to this nerve results in:

Loss of shoulder elevation
Hoarseness or voice changes (Correct answer)
Loss of taste from the anterior tongue
Inability to swallow liquids

Correct answer: Hoarseness or voice changes

The recurrent laryngeal nerve innervates all intrinsic laryngeal muscles except the cricothyroid; injury causes hoarseness, and bilateral injury can cause airway obstruction.

Question 113: During a laparoscopic procedure, CO2 insufflation is used primarily to:

Cool the abdominal organs during surgery
Reduce the risk of gas embolism
Create pneumoperitoneum for visualization and instrument access (Correct answer)
Prevent bacterial contamination of the peritoneal cavity

Correct answer: Create pneumoperitoneum for visualization and instrument access

CO2 insufflation creates pneumoperitoneum, expanding the abdominal cavity to allow visualization and manipulation of organs during laparoscopic surgery.

Question 114: Which items are included in a complete surgical count per AORN standards?

Sharps and sponges only
Instruments only
Sponges, sharps, and instruments (Correct answer)
Sponges only

Correct answer: Sponges, sharps, and instruments

AORN standards require counting sponges, sharps (needles, blades), and instruments to prevent any item from being retained.

Question 115: A patient is placed in the lithotomy position. The MOST important complication to monitor for during extended procedures is:

Brachial plexus injury
Corneal abrasion
Compartment syndrome of the lower extremities (Correct answer)
Pressure ulcer on the occiput

Correct answer: Compartment syndrome of the lower extremities

Prolonged lithotomy position compresses the lower extremity compartments and can cause compartment syndrome, a serious, potentially limb-threatening complication.

Question 116: If a sponge is added to the sterile field AFTER the initial count, what must occur?

No action is needed until the closing count
A new count sheet must be started from zero
The added sponge must be counted and included in the running total (Correct answer)
The surgeon must personally recount all sponges

Correct answer: The added sponge must be counted and included in the running total

Any item added to the sterile field mid-procedure must be immediately counted and added to the existing tally to maintain accuracy.

Question 117: What is the primary purpose of a trocar in laparoscopic surgery?

To cut tissue during insufflation
To provide a port of entry for instruments through the abdominal wall (Correct answer)
To measure intraabdominal pressure
To aspirate blood from the peritoneal cavity

Correct answer: To provide a port of entry for instruments through the abdominal wall

A trocar creates and maintains a port of entry through the abdominal wall for laparoscopic instruments and the camera.

Question 118: What is the correct chlorhexidine gluconate (CHG) skin prep technique for a patient with iodine sensitivity?

No skin preparation is needed if the patient is allergic to iodine
Use only sterile saline for patients with iodine allergies
Use povidone-iodine but apply it in smaller amounts
CHG is an appropriate iodine-free alternative for surgical skin preparation (Correct answer)

Correct answer: CHG is an appropriate iodine-free alternative for surgical skin preparation

Chlorhexidine gluconate does not contain iodine and provides excellent broad-spectrum antimicrobial coverage as an alternative prep agent for iodine-sensitive patients.

Question 119: The surgical technologist passes a hemostat to the surgeon who hands it back contaminated with blood. The correct action is to:

Wipe it with a sterile sponge and return it to the sterile field (Correct answer)
Clean it with a sterile saline-soaked sponge and reuse it
Remove it from the sterile field and replace with a clean instrument
Place it in the kick bucket immediately

Correct answer: Wipe it with a sterile sponge and return it to the sterile field

Blood-contaminated instruments should be wiped with a sterile sponge to remove gross debris and returned to the sterile field; they remain sterile unless sterility is otherwise compromised.

Question 120: Which type of forceps is commonly used to grasp the dura mater during neurosurgical procedures?

Adson forceps
Russian forceps
DeBakey forceps
Cushing forceps (Correct answer)

Correct answer: Cushing forceps

Cushing forceps are fine-tipped tissue forceps specifically designed for handling delicate neurosurgical tissues such as the dura mater.

Question 121: Which tendon is most commonly ruptured in an Achilles tendon repair procedure?

Tibialis posterior tendon
Peroneus longus tendon
Calcaneal (Achilles) tendon (Correct answer)
Flexor hallucis longus tendon

Correct answer: Calcaneal (Achilles) tendon

The calcaneal (Achilles) tendon, formed by the gastrocnemius and soleus muscles, is the thickest tendon in the body and most commonly repaired after rupture.

Question 122: Which middle ear ossicle has the oval window covered?

stapes (Correct answer)
85
daily
parasitism

Correct answer: stapes

The stapes, also known as the stirrup, is the smallest bone in the human body and one of the three ossicles in the middle ear. Its footplate fits into and covers the oval window, a membrane-covered opening that connects the middle ear to the inner ear. The stapes transmits sound vibrations from the incus to the fluid-filled cochlea, playing a critical role in hearing.

Question 123: Which of the following describes the 'scrub role' of the surgical technologist?

Managing the sterile field and passing instruments (Correct answer)
Operating the endoscopy equipment from outside the sterile field
Monitoring anesthesia levels
Coordinating the surgical schedule

Correct answer: Managing the sterile field and passing instruments

The scrub surgical technologist maintains the sterile field, prepares instruments, and passes them to the surgeon during the procedure.

Question 124: When passing a sharp instrument during surgery, the BEST method to maintain safety and sterility is:

Toss the instrument to the surgeon's dominant hand
Use the neutral/hands-free technique on a designated zone (Correct answer)
Drop it onto the sterile field from above
Hand it directly handle-first to the surgeon

Correct answer: Use the neutral/hands-free technique on a designated zone

The neutral or hands-free technique places the instrument in a designated zone to prevent needlestick injuries while maintaining sterility.

Question 125: The scrub technologist's primary responsibility during surgical counts is to:

Perform post-procedure verification in the PACU
Document all count results in the patient's chart
Count instruments only, while the circulator handles sponges
Participate in the count and immediately report discrepancies to the circulator (Correct answer)

Correct answer: Participate in the count and immediately report discrepancies to the circulator

The scrub technologist counts alongside the circulating nurse and must communicate any discrepancy immediately so corrective action can be taken.

Question 126: What does the term 'half-life' of a drug refer to in pharmacokinetics?

Time required for first-pass metabolism
Time for the drug to reach peak effect
Time for 50% of the drug to be eliminated from the body (Correct answer)
Duration of the drug's therapeutic effect

Correct answer: Time for 50% of the drug to be eliminated from the body

Half-life (t½) is the time required for plasma concentration of a drug to decrease by 50%, which determines dosing intervals and time to steady state.

Question 127: When administering furosemide to a patient, which of the following interventions must the nurse take into account?

Keep an eye out for the patient's face flushing and tachypnea.
Both A and C (Correct answer)
Give the medication carefully, over about two minutes.
After administration, check and record the patient's potassium levels.

Correct answer: Both A and C

Furosemide is a potent loop diuretic that can cause significant electrolyte imbalances, particularly hypokalemia. Therefore, monitoring potassium levels after administration is crucial to prevent complications. Additionally, administering furosemide intravenously too rapidly can lead to ototoxicity and hypotension, so it should be given carefully over about two minutes to mitigate these risks.

Question 128: What kind of operation would require tooth removal?

systolic
bacillus
extractions (Correct answer)
insulin

Correct answer: extractions

The correct answer is extractions. Tooth removal is medically referred to as a dental extraction. This procedure is performed when a tooth is severely damaged, decayed, impacted, or causing overcrowding, and cannot be saved through other dental treatments.

Question 129: A patient arrives in the preoperative holding area for a hernia repair. The surgical technologist's review of the patient's chart is an essential part of the preparation. Which of the following findings should be immediately reported to the surgeon and anesthesia provider?

The patient reports taking their prescribed blood pressure medication with a sip of water this morning.
The patient has a documented allergy to latex.
The patient's history and physical was completed yesterday.
The patient states they had a bowl of cereal two hours ago. (Correct answer)

Correct answer: The patient states they had a bowl of cereal two hours ago.

Violating NPO (nothing by mouth) guidelines significantly increases the risk of pulmonary aspiration during anesthesia. Having solid food two hours before surgery is a major safety concern that must be communicated immediately, as it may lead to the delay or cancellation of the procedure. A latex allergy is important but managed with latex-free supplies. Taking essential medication with a sip of water is often permitted. A recent H&P is standard.

Question 130: During a right hemicolectomy, the surgical technologist should anticipate which anastomosis type?

Esophagogastrostomy
Ileocolostomy (Correct answer)
Jejuno-jejunostomy
Colorectal anastomosis

Correct answer: Ileocolostomy

Right hemicolectomy removes the right colon and terminal ileum, requiring an ileocolostomy to reconnect the ileum to the remaining colon.

Question 131: Which early postoperative complication is most common following general anesthesia?

Deep vein thrombosis
Urinary retention
Wound infection
Atelectasis (partial lung collapse) (Correct answer)

Correct answer: Atelectasis (partial lung collapse)

Atelectasis — collapse of alveoli due to shallow breathing, supine positioning, and retained secretions — is the most common early complication after general anesthesia.

Question 132: During sterilizer load configuration, heavy instrument sets should be placed:

On top of lighter items
Horizontally on the top shelf
Interspersed randomly throughout the load
On the bottom shelf of the sterilizer (Correct answer)

Correct answer: On the bottom shelf of the sterilizer

Heavy instrument sets belong on the bottom shelf to allow condensate to drain away and steam to penetrate properly without damaging lighter items.

Question 133: A patient with a documented latex allergy is scheduled for surgery. Which glove material should the surgical team use?

Powdered latex gloves
Vinyl gloves for all team members
Latex gloves without powder
Neoprene or nitrile synthetic gloves (Correct answer)

Correct answer: Neoprene or nitrile synthetic gloves

Neoprene or nitrile synthetic gloves are the appropriate latex-free alternative for patients and staff with latex allergies.

Question 134: Which layer of the surgical drape is considered the sterile field boundary?

The entire drape surface
The top surface of the drape at table level and above (Correct answer)
The underside of the drape closest to the patient
Only the area directly over the incision site

Correct answer: The top surface of the drape at table level and above

The sterile field includes the top surface of the drape at table level and above; anything below table level is considered contaminated.

Question 135: When passing a sharps instrument on the sterile field, the safest technique is:

Toss the instrument gently across the field
Hand-to-hand directly to the surgeon
Recap the needle before passing
Place in a neutral zone and announce its placement (Correct answer)

Correct answer: Place in a neutral zone and announce its placement

The neutral zone technique requires placing sharps in a designated area and announcing placement, eliminating hand-to-hand transfer and reducing sharps injuries.

Question 136: Which systemic condition MOST significantly impairs postoperative wound healing?

Young adult age
Uncontrolled diabetes mellitus (Correct answer)
Adequate preoperative nutritional status
Normal body mass index

Correct answer: Uncontrolled diabetes mellitus

Uncontrolled diabetes impairs wound healing through microvascular disease, impaired neutrophil function, and altered collagen synthesis, greatly increasing infection and dehiscence risk.

Question 137: Hair should be removed in the following order before cranial surgery:

Discarded
Sent to pathology
Saved for possible transplant
Saved because it is personal property (Correct answer)

Correct answer: Saved because it is personal property

Before cranial surgery, if hair needs to be removed, it should be saved and treated as the patient's personal property. This respects the patient's autonomy and personal belongings, as hair can hold significant personal or cultural value. The removed hair should be placed in a labeled bag and returned to the patient or their family after the procedure.

Question 138: During a craniotomy, the surgical technologist should have which instrument ready to control bleeding from the bone edges?

Gelfoam pledgets only
Electrosurgical pencil only
Bone rongeur
Bone wax (Correct answer)

Correct answer: Bone wax

Bone wax is a sterile beeswax preparation applied to the cut edges of bone to mechanically occlude bleeding from bone marrow vessels.

Question 139: Which organ is retroperitoneal and is therefore NOT covered by visceral peritoneum on all sides?

Pancreas (body and tail) (Correct answer)
Stomach
Spleen
Liver

Correct answer: Pancreas (body and tail)

The pancreas (except the tail) is retroperitoneal and lies behind the peritoneum, making it secondarily retroperitoneal with only an anterior peritoneal covering.

Question 140: What is the primary purpose of the preoperative surgical site marking?

To mark areas for antiseptic application only
To indicate placement of the electrosurgical dispersive pad
To ensure the correct site and side are operated on (Correct answer)
To identify the incision length for billing purposes

Correct answer: To ensure the correct site and side are operated on

Surgical site marking is a patient safety measure to prevent wrong-site surgery by clearly identifying the correct operative location.

Question 141: How should the stretcher be positioned when an elevator moves a patient to the or?

Enter head first, exit feet first (Correct answer)
Name, date of birth, physician
Repositioning penetrating towel clip
Acromioclavicular joint to iliac crest

Correct answer: Enter head first, exit feet first

When transporting a patient on a stretcher in an elevator to the operating room, the stretcher should enter head first and exit feet first. This protocol ensures that the patient's head is always facing the direction of travel when entering or exiting the elevator. This allows the transporter to maintain visual contact with the patient's face and airway, and to react quickly in case of an emergency.

Question 142: A sterile field has been set up and left unattended for 30 minutes. What is the correct action?

Cover the field with a sterile drape and continue
Ask the circulator to verify sterility
Consider the field contaminated and set up a new one (Correct answer)
Use the field if it appears untouched

Correct answer: Consider the field contaminated and set up a new one

A sterile field that has been left unattended and unwatched is considered contaminated and must be replaced.

Question 143: The chain of asepsis is broken when a scrubbed team member:

Keeps hands clasped above waist level between instrument passes
Accepts a sterile supply item dropped onto the back table
Faces the sterile field while moving around the table
Reaches below the level of the sterile drape to retrieve a fallen item (Correct answer)

Correct answer: Reaches below the level of the sterile drape to retrieve a fallen item

Reaching below table level contacts the non-sterile zone; anything below the sterile drape edge is considered contaminated.

Question 144: During a laparoscopic procedure, CO2 insufflation pressure is typically maintained at:

5–8 mmHg
10–15 mmHg (Correct answer)
20–25 mmHg
30–35 mmHg

Correct answer: 10–15 mmHg

CO2 pneumoperitoneum is maintained at 10–15 mmHg to provide adequate visualization while minimizing hemodynamic and respiratory effects.

Question 145: What is the purpose of applying sequential compression devices (SCDs) preoperatively?

To stabilize the lower extremities during positioning
To monitor arterial blood pressure continuously during surgery
To measure leg compartment pressures intraoperatively
To prevent deep vein thrombosis by promoting venous return (Correct answer)

Correct answer: To prevent deep vein thrombosis by promoting venous return

SCDs apply intermittent pneumatic compression to the legs, promoting venous return and reducing the risk of deep vein thrombosis during prolonged surgery.

Question 146: An incorrect count at skin closure requires which actions?

Radiograph of the operative site only
Documentation of the discrepancy in the chart only
Both immediate notification of the surgeon and an intraoperative radiograph (Correct answer)
Immediate notification of the surgeon only

Correct answer: Both immediate notification of the surgeon and an intraoperative radiograph

A count discrepancy at closure requires notifying the surgeon immediately AND obtaining an intraoperative X-ray to rule out a retained surgical item before the patient leaves the OR.

Question 147: What is the primary purpose of the surgical hand scrub before gowning and gloving?

Replace the need for sterile gloves
Reduce transient and resident flora on hands and forearms (Correct answer)
Achieve surgical-site sterility
Eliminate all microorganisms permanently

Correct answer: Reduce transient and resident flora on hands and forearms

The surgical hand scrub reduces transient and a significant portion of resident flora on hands and forearms, but does not achieve full sterilization.

Question 148: What is the first part of the small intestine?

love
fistula
duodenum (Correct answer)
cerumen

Correct answer: duodenum

The duodenum is the first and shortest segment of the small intestine, immediately following the stomach. It plays a crucial role in digestion by receiving partially digested food (chyme) and mixing it with digestive enzymes from the pancreas and bile from the liver. This initial segment is where most chemical digestion occurs before absorption primarily takes place in the jejunum and ileum.

Question 149: Which suture material is contraindicated in patients with known hypersensitivity reactions to bovine or ovine collagen products?

Polyester (Ethibond)
Plain or chromic gut (Correct answer)
Polypropylene (Prolene)
Polyglycolic acid (Dexon)

Correct answer: Plain or chromic gut

Plain and chromic gut sutures are derived from sheep intestinal submucosa or bovine serosa and can trigger allergic reactions in sensitized patients.

Question 150: Which anatomical structure must be identified and protected during a radical mastectomy to preserve arm function?

Radial nerve
Ulnar nerve
Brachial artery
Long thoracic nerve (Correct answer)

Correct answer: Long thoracic nerve

The long thoracic nerve innervates the serratus anterior muscle; injury causes 'winged scapula' and loss of arm elevation.

Question 151: Hydrogen peroxide plasma sterilization is CONTRAINDICATED for which type of items?

Rigid endoscopes
Titanium implants
Linens and cellulose-based materials (Correct answer)
Stainless steel instruments

Correct answer: Linens and cellulose-based materials

Hydrogen peroxide plasma sterilization cannot be used for cellulose-based materials (e.g., linen, paper) because they absorb the hydrogen peroxide and disrupt the cycle.

Question 152: A patient is undergoing a repair of the rotator cuff. Which of the following muscles is NOT part of this functional group?

Teres minor
Supraspinatus
Subscapularis
Teres major (Correct answer)

Correct answer: Teres major

The rotator cuff is composed of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis (often remembered by the acronym SITS). The teres major is located near the rotator cuff muscles but is not part of the functional group; it works to adduct and medially rotate the humerus.

Question 153: When a count discrepancy is identified at wound closure, what is the FIRST action?

Notify the charge nurse
Perform a recount of all items (Correct answer)
Request a radiograph immediately
Document the discrepancy and proceed

Correct answer: Perform a recount of all items

A recount is performed first to rule out a counting error before escalating to a radiograph or other measures.

Question 154: Which item is considered the MOST critical item requiring sterilization (per Spaulding Classification)?

Blood pressure cuff
Flexible sigmoidoscope
Surgical instruments entering sterile tissue (Correct answer)
Laryngoscope blade

Correct answer: Surgical instruments entering sterile tissue

Per the Spaulding Classification, critical items are those that enter sterile tissue or the vascular system and must be sterilized.

Question 155: What number of white blood cells in an adult is considered normal?

20000 to 25000
5000 to 9000 (Correct answer)
1000 to 2000
12000 to 15000

Correct answer: 5000 to 9000

A normal white blood cell (WBC) count in an adult typically ranges from 5,000 to 9,000 cells per microliter of blood. White blood cells, or leukocytes, are crucial components of the immune system, fighting off infections and other diseases. Counts outside this range can indicate underlying medical conditions, such as infection (leukocytosis) or immunosuppression (leukopenia).

Question 156: During the healing process following surgery, which of the following nursing diagnoses is the patient most likely to have?

Disorientation and confusion
Altered nutrition, less than bodily requirements
Dysfunctional grieving
Ineffective thermoregulation (Correct answer)

Correct answer: Ineffective thermoregulation

Ineffective thermoregulation, often manifesting as hypothermia, is a very common nursing diagnosis in the immediate post-operative period. Patients are susceptible to heat loss due to anesthesia, exposure in the operating room, and altered physiological responses. Maintaining normothermia is crucial for optimal recovery and preventing complications.

Question 157: Which organization establishes the standards for surgical counts in the United States?

FDA
CDC
CMS
AORN (Correct answer)

Correct answer: AORN

The Association of periOperative Registered Nurses (AORN) publishes evidence-based guidelines for surgical counts and patient safety.

Question 158: The purpose of a biological indicator (BI) in sterilization monitoring is to:

Monitor chemical changes on the outside of sterilization pouches
Check that the sterilizer door sealed properly during the cycle
Verify that the correct temperature was reached inside the sterilizer
Confirm sterilization efficacy using the most resistant microorganisms (Correct answer)

Correct answer: Confirm sterilization efficacy using the most resistant microorganisms

Biological indicators contain spores of highly resistant organisms (e.g., Geobacillus stearothermophilus) to confirm that sterilization conditions were lethal to all microorganisms.

Question 159: The term used to describe anesthesia that combines an inhalation drug, a narcotic, a hypnotic-sedative, and a muscle relaxant is:

General anesthesia
Regional anesthesia
Local anesthesia
Balanced anesthesia (Correct answer)

Correct answer: Balanced anesthesia

Explanation: <br> Balanced anesthesia is the name given to the type of anesthesia that combines hypnotic-sedatives, narcotics, muscle relaxants, and inhalation drugs. Similar to general anesthesia, this form of anesthesia has repercussions. The most frequent usage for it is during surgery when the patient requires general anesthesia for sleep.

Question 160: Which layer of the surgical drape placed directly on the patient must be sterile?

Both inner and outer layers
Neither layer requires sterility
The inner (patient-contact) layer (Correct answer)
The outer layer only

Correct answer: The inner (patient-contact) layer

The innermost surface of the drape that contacts the patient and sterile field must be sterile to maintain asepsis.

Question 161: Which position places the patient flat on their back with legs elevated in stirrups?

Trendelenburg
Reverse Trendelenburg
Lithotomy (Correct answer)
Lateral decubitus

Correct answer: Lithotomy

Lithotomy position has the patient supine with hips flexed and legs elevated in stirrups, used for gynecological, urological, and colorectal procedures.

Question 162: What needs to be discussed by the nurse before using Hypaque for arteriography?

What is the patient’s ethnic background?
Does the patient have anxiety?
Does the patient have high blood pressure?
Is the patient allergic to shellfish? (Correct answer)

Correct answer: Is the patient allergic to shellfish?

Hypaque is an iodinated contrast agent used in arteriography. Patients with a known allergy to shellfish often have a cross-sensitivity to iodine-based contrast media due to the presence of iodine in shellfish. Therefore, screening for shellfish allergies is crucial to prevent potentially severe allergic reactions to the contrast agent.

Question 163: Which preoperative lab value is most critical to review before a patient undergoes general anesthesia?

Urine specific gravity
Serum calcium
Hemoglobin and hematocrit (Correct answer)
Serum albumin

Correct answer: Hemoglobin and hematocrit

Hemoglobin and hematocrit values indicate oxygen-carrying capacity and identify anemia that could compromise patient safety during general anesthesia.

Question 164: What is 'strike-through contamination' on a sterile field?

Contamination from airborne particles falling onto the field
Contamination from a team member's ungloved hands
Contamination caused by expired sterilization indicators
Contamination caused by fluid soaking through a sterile barrier to non-sterile surfaces and back (Correct answer)

Correct answer: Contamination caused by fluid soaking through a sterile barrier to non-sterile surfaces and back

Strike-through contamination occurs when moisture passes through a sterile barrier to a non-sterile surface and wicks back, rendering the barrier non-sterile.

Question 165: Which layer of the abdominal wall is the deepest fascial layer encountered before reaching the peritoneum?

Transversalis fascia (Correct answer)
External oblique fascia
Scarpa's fascia
Camper's fascia

Correct answer: Transversalis fascia

Transversalis fascia lies just deep to the transversus abdominis muscle and directly superficial to the peritoneum.

Question 166: When should the scrub technologist notify the surgeon of a count discrepancy?

Immediately upon identifying the discrepancy (Correct answer)
Only if the discrepancy cannot be resolved after two recounts
After the wound is fully closed
At the end of the procedure during sign-out

Correct answer: Immediately upon identifying the discrepancy

Immediate notification of the surgeon is required so the wound can be explored before closure, preventing a retained surgical item.

Question 167: During a procedure, the scrub technologist's gown sleeve accidentally touches the non-sterile kick bucket. What should occur?

Continue the procedure carefully
Inform the surgeon and change gown (Correct answer)
Rinse the sleeve with sterile saline
Apply sterile drape over the sleeve

Correct answer: Inform the surgeon and change gown

Any contact between a sterile gown and a non-sterile surface renders that area contaminated; the gown must be changed.

Question 168: When a scrub technologist needs to reposition at the sterile field, they should pass another sterile team member by:

Passing back-to-back (Correct answer)
Passing front-to-front
Stepping around the non-sterile side
Asking the circulator to rearrange the field

Correct answer: Passing back-to-back

Sterile team members pass back-to-back or front-to-front (facing) to avoid contaminating each other's sterile fronts.

Question 169: During the preoperative assessment, the patient reports a latex allergy. Which action should occur FIRST?

Continue preparation and document the allergy in the chart only
Delay surgery until a latex-free OR suite is built
Apply a latex allergy wristband and alert the entire surgical team (Correct answer)
Switch all gloves to vinyl and proceed without further precautions

Correct answer: Apply a latex allergy wristband and alert the entire surgical team

Immediately applying a latex allergy wristband and alerting all team members ensures the entire OR is prepared with latex-free supplies before the patient enters.

Question 170: As part of a preoperative process, the nurse is getting ready to place a nasogastric tube inside of a patient. Which of the following statements about nasogastric tube placement is accurate?

To help the tube proceed during the surgery, the patient might need to drink water. (Correct answer)
Both B and C
A CT scan is used to confirm where the nasogastric tube should be placed.
During placement, the patient is positioned in the reverse-Trendelenburg position.

Correct answer: To help the tube proceed during the surgery, the patient might need to drink water.

During nasogastric (NG) tube insertion, having the patient swallow or drink sips of water can facilitate the tube's passage down the esophagus. Swallowing helps to open the epiglottis and guide the tube into the esophagus rather than the trachea. This makes the insertion process smoother, reduces discomfort, and is a common technique to aid NG tube placement.

Question 171: Where should a patient be placed for a temporal craniectomy by the perioperative nurse?

Prone
Lateral recumbent
Sitting (Correct answer)
Supine

Correct answer: Sitting

For a temporal craniectomy, which involves accessing the temporal lobe of the brain, the sitting position is often preferred. This position allows for optimal surgical access to the temporal region and facilitates venous drainage to reduce intracranial pressure. Proper padding and support are crucial to prevent nerve damage and ensure patient safety.

Question 172: The purpose of a self-retaining retractor such as a Balfour retractor is to:

Provide counter-traction during fascial closure
Hold the wound open without requiring manual effort (Correct answer)
Provide manual retraction by the assistant
Retract delicate neurovascular structures

Correct answer: Hold the wound open without requiring manual effort

Self-retaining retractors like the Balfour maintain wound exposure independently, freeing surgical team members from manual retraction duties.

Question 173: Which instrument is used to compress and occlude the fallopian tube during tubal ligation?

Pratt cervical dilator
Fogarty clamp
Hulka clip applicator (Correct answer)
Sims uterine sound

Correct answer: Hulka clip applicator

The Hulka clip applicator is used to apply a mechanical clip to the fallopian tube to occlude it during laparoscopic tubal ligation.

Question 174: The primary purpose of maintaining normothermia (normal body temperature) during surgery is to:

Lower the metabolic rate to reduce oxygen demand
Prevent coagulopathy, surgical site infection, and cardiac events (Correct answer)
Facilitate more effective anesthetic drug metabolism
Reduce the patient's awareness of pain postoperatively

Correct answer: Prevent coagulopathy, surgical site infection, and cardiac events

Normothermia prevents hypothermia-induced coagulopathy, impaired immune function leading to SSI, and cardiac dysrhythmias that increase morbidity.

Question 175: Wound dehiscence is defined as:

Undermining of wound edges by bacteria
Excessive fibrotic scar tissue formation
Separation of the approximated wound edges (Correct answer)
Purulent infection of a surgical wound

Correct answer: Separation of the approximated wound edges

Dehiscence refers to the partial or complete separation of wound edges after closure, most commonly seen within the first postoperative week.

Question 176: Which flash (IUSS) sterilization cycle parameter is correct for unwrapped, non-porous metal instruments in a pre-vacuum sterilizer?

132°C for 10 minutes
132°C for 3 minutes
121°C for 10 minutes
134°C for 3 minutes (Correct answer)

Correct answer: 134°C for 3 minutes

IUSS guidelines specify 134°C for 3 minutes for unwrapped non-porous items in a pre-vacuum sterilizer.

Certified Surgical Technologist (CST) Exam

The CST exam certifies surgical technologists who possess the knowledge and skills to provide patient care in the operating room, ensuring a safe and sterile surgical environment.

175

Questions

150 min

Time Limit

70%

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