AORN AORN Surgical Counts and Accountability 2 — Questions and Answers
Question 1: What is the purpose of the X-ray detectable strip in surgical sponges?
- To identify sponges on intraoperative X-ray if a count discrepancy occurs (Correct answer)
- To prevent sponge absorption into tissues
- To allow sponges to be reused after sterilization
- To distinguish surgical sponges from dressing sponges
Correct answer: To identify sponges on intraoperative X-ray if a count discrepancy occurs
The radiopaque strip enables identification of retained surgical sponges via X-ray when a count discrepancy cannot be resolved by manual search.
Question 2: When additional sponges or instruments are added to the sterile field during a procedure, what must occur?
- They must be counted and added to the count record immediately (Correct answer)
- They must be counted only at the closing count
- They may be added without counting if the surgeon authorizes it
- They should be held off the field until the final count
Correct answer: They must be counted and added to the count record immediately
Any item added to the sterile field mid-procedure must be immediately counted and documented to maintain an accurate running count.
Question 3: A surgeon requests that the perioperative team skip the instrument count to save time. What is the correct nursing response?
- Decline to skip the count and explain the patient safety rationale (Correct answer)
- Skip the count and document the surgeon's request
- Perform a partial count of only major instruments
- Allow the count to be skipped if the surgery is under 30 minutes
Correct answer: Decline to skip the count and explain the patient safety rationale
Perioperative nurses are professionally obligated to perform all required counts regardless of a surgeon's request, as counts are a patient safety standard of care.
Question 4: Which documentation is required after every surgical count according to AORN?
- The count result (correct or incorrect), time, and names of personnel who performed the count (Correct answer)
- Only the final count result and surgeon's signature
- The count result and the circulating nurse's initials only
- Documentation is only required when a discrepancy occurs
Correct answer: The count result (correct or incorrect), time, and names of personnel who performed the count
AORN requires documentation of each count result, the time it was performed, and the names of both personnel who performed the count.
Question 5: What should be done with a sponge that has been cut or modified during the surgical procedure?
- Keep all pieces together and count them as one item throughout the procedure (Correct answer)
- Discard the cut sponge and replace it with a new one from the count
- Remove the cut sponge from the count and document removal
- Count the pieces separately as individual items
Correct answer: Keep all pieces together and count them as one item throughout the procedure
When a sponge is cut, all pieces must be kept together and counted as a single unit to prevent counting discrepancies.
Question 6: During an emergency situation requiring rapid closure, a count discrepancy is noted. What is the most appropriate action?
- Notify the surgeon of the discrepancy, obtain an intraoperative X-ray, and document the events (Correct answer)
- Proceed with closure and perform a postoperative X-ray only if symptoms arise
- Document the discrepancy and close the wound per surgeon direction
- Delay closure until the missing item is physically found
Correct answer: Notify the surgeon of the discrepancy, obtain an intraoperative X-ray, and document the events
Even in emergencies, a discrepancy must be reported to the surgeon, an X-ray obtained when clinically feasible, and all events thoroughly documented.
AORN AORN Surgical Counts and Accountability 2
What is the purpose of the X-ray detectable strip in surgical sponges?