Certified Surgical Technologist (CST) Exam — Questions and Answers

Question 1: What is the minimum recommended distance a non-sterile person should maintain from a sterile field?

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

Correct answer: 18 inches

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

Question 2: 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?

Insert a suction catheter into the tube and apply suction while pulling the tube out (Correct answer)
To make it easier to remove the tube, bend the patient's head downward and toward the chest
Apply cricoid pressure to the neck while carefully removing the tube with the thumb and forefinger
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 3: Which surgical position is used for retroperitoneal flank access during kidney (nephrectomy) surgery?

Supine with arm extended
Fowler's position
Prone with Wilson frame
Lateral (kidney) position (Correct answer)

Correct answer: Lateral (kidney) position

The lateral position with the patient's flank over the kidney rest and table flexed provides direct retroperitoneal access for nephrectomy and other kidney procedures.

Question 4: When using the Bovie electrosurgical unit, the dispersive electrode (grounding pad) should be placed:

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 a bony prominence close to the operative site
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 5: When a patient is on anticoagulation therapy with warfarin, which lab value must be monitored preoperatively?

International normalized ratio (INR) (Correct answer)
Platelet count
Partial thromboplastin time (PTT)
Bleeding time

Correct answer: International normalized ratio (INR)

INR measures the extrinsic coagulation pathway affected by warfarin; a therapeutic INR for most indications is 2.0–3.0, and surgery typically requires it below 1.5.

Question 6: Which item is necessary to set up a D&C?

Cassette holder
Cell-saver unit
Stirrups (Correct answer)
Electrosurgery unit

Correct answer: Stirrups

A Dilation and Curettage (D&C) procedure requires the patient to be placed in the lithotomy position. Stirrups are essential equipment used to support the patient's legs in this position, allowing for proper exposure and access to the perineal and vaginal areas. This setup is crucial for the surgeon to perform the procedure effectively.

Question 7: During a prostatectomy, which nerve bundles running posterolateral to the prostate must be preserved to maintain erectile function?

Neurovascular bundles of Walsh (Correct answer)
Pudendal nerve bundles
Pelvic splanchnic nerve bundles
Obturator nerve bundles

Correct answer: Neurovascular bundles of Walsh

The neurovascular bundles of Walsh run posterolateral to the prostate and contain the cavernous nerves responsible for erectile function.

Question 8: Which sterilization method uses peracetic acid and is suitable for immersible, heat-sensitive instruments in a liquid cycle?

STERIS System 1E (peracetic acid) (Correct answer)
STERRAD (hydrogen peroxide plasma)
Ethylene oxide
Dry heat sterilization

Correct answer: STERIS System 1E (peracetic acid)

The STERIS System 1E uses peracetic acid in a liquid sterilization cycle for immersible, heat-sensitive instruments.

Question 9: What is the FIRST priority when handing off a patient to the PACU nurse?

Reporting airway status and current vital signs (Correct answer)
Listing all surgical instruments used in the case
Reporting all IV fluids and blood products administered
Reviewing the final surgical count results

Correct answer: Reporting airway status and current vital signs

Airway patency and hemodynamic stability are the immediate life-safety priorities during PACU handoff — all other information is secondary.

Question 10: Which organization establishes the standards for surgical counts in the United States?

AORN (Correct answer)
CDC
FDA
CMS

Correct answer: AORN

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

Question 11: Which agent is classified as a high-level disinfectant (HLD) and used for heat-sensitive semi-critical items?

Chlorhexidine gluconate 4%
Glutaraldehyde 2% (Correct answer)
Povidone-iodine 10%
Isopropyl alcohol 70%

Correct answer: Glutaraldehyde 2%

Glutaraldehyde 2% is a high-level disinfectant used for semi-critical items that cannot withstand heat sterilization.

Question 12: A patient is placed in the lithotomy position. The MOST important complication to monitor for during extended procedures is:

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

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

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

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

Prone
Lithotomy
Lateral
Supine (Correct answer)

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

Teres minor
Subscapularis
Infraspinatus
Supraspinatus (Correct answer)

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 16: Which document must be completed and signed before a patient can be transported to the OR for an elective surgical procedure?

Informed consent (Correct answer)
NPO confirmation form
Advance directive
Insurance authorization

Correct answer: Informed consent

Informed consent must be obtained and signed by the patient or legal guardian before any elective surgical procedure can proceed.

Question 17: The Universal Protocol for preventing wrong-site surgery was established by which organization?

AORN
AST
WHO
The Joint Commission (Correct answer)

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 18: The common bile duct joins the pancreatic duct at which structure before emptying into the duodenum?

Ampulla of Vater (Correct answer)
Sphincter of Oddi
Hartmann's pouch
Cystic duct

Correct answer: Ampulla of Vater

The common bile duct and pancreatic duct merge at the ampulla of Vater (hepatopancreatic ampulla) before entering the duodenum through the sphincter of Oddi.

Question 19: Which action is correct when a sterile team member must turn their back during a procedure?

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

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 20: Which of the following is an advantage of using depilatory cream to the skin prior to surgery?

In some circumstances, the patient may use the cream on their own skin.
Both A and C (Correct answer)
The skin at the surgery site remains intact.
Applying the cream is a cleaner method of hair removal than shaving.

Correct answer: Both A and C

Explanation: The use of depilatory cream as part of skin preparation prior to surgery has the advantages of keeping the skin at the surgical site intact and, in some cases, allowing the patient to apply the cream themselves. Depilatory lotion maintains the skin intact and makes it less likely to contract an infection by avoiding cutting or shaving for hair removal. It is simple to use, and in some private circumstances, the patient could feel more at ease using the cream themselves.

Question 21: When donning a sterile gown and gloves using the closed-gloving technique, which part of the gown is considered non-sterile?

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.
The front of the gown from chest to the level of the sterile field.

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 22: 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 23: During a total knee arthroplasty, the surgeon uses a pneumatic tourniquet. What is the maximum recommended inflation time to prevent ischemic injury?

30 minutes
60 minutes
90 minutes (Correct answer)
120 minutes

Correct answer: 90 minutes

Pneumatic tourniquet inflation is generally limited to 90 minutes to reduce the risk of ischemia, nerve damage, and compartment syndrome.

Question 24: What is the purpose of the 'time-out' performed immediately before a surgical incision?

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

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 25: A patient states they ate a full meal 3 hours before arriving for a scheduled procedure. What should the surgical technologist do?

Notify the surgeon and anesthesia provider before the procedure begins (Correct answer)
Proceed with the case since 3 hours is adequate fasting time
Administer an antiemetic and continue with preparation
Document the information and do not inform anyone

Correct answer: Notify the surgeon and anesthesia provider before the procedure begins

NPO status of at least 6-8 hours for solids is required; a non-fasted patient is at risk for aspiration and the team must be notified to determine if surgery can proceed.

Question 26: The Mayfield skull clamp provides rigid head fixation most commonly used for:

Craniotomies in lateral, prone, or sitting positions (Correct answer)
Abdominal laparoscopy in Trendelenburg
Shoulder surgery in beach chair
Lithotomy perineal procedures

Correct answer: Craniotomies in lateral, prone, or sitting positions

The Mayfield three-pin skull clamp attaches to the skull and table frame to prevent any head movement during craniotomies, regardless of the patient's body position.

Question 27: During a procedure on a patient's hand, the surgeon requests "Xylocaine with epinephrine." The surgical technologist notes the scheduled procedure is a digital nerve block for the index finger. What is the most critical concern with this request?

The patient may have an allergic reaction to Xylocaine.
Epinephrine will shorten the duration of the anesthetic effect.
Epinephrine can cause severe vasoconstriction, leading to digital ischemia. (Correct answer)
The combination is only effective for spinal anesthesia.

Correct answer: Epinephrine can cause severe vasoconstriction, leading to digital ischemia.

Epinephrine is a potent vasoconstrictor. Its use in areas with end-arterial circulation, such as fingers, toes, the nose, and the penis, is traditionally contraindicated because it can restrict blood flow to the point of causing tissue necrosis.

Question 28: During the healing process following surgery, which of the following nursing diagnoses is the patient most likely to have?

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

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

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

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 30: During a surgical procedure, a circulating nurse reaches over the sterile back table to retrieve an item. Which principle of aseptic technique has been violated?

Sterile items should be kept separate from non-sterile items.
The edges of a sterile container are considered unsterile.
The sterile field should be created as close as possible to the time of use.
Non-sterile individuals should not reach over a sterile field. (Correct answer)

Correct answer: Non-sterile individuals should not reach over a sterile field.

A fundamental principle of aseptic technique is that non-sterile persons must never reach over a sterile field. Doing so can cause shedding of microbes, dust, or other particles from the non-sterile person onto the sterile surface, leading to contamination. Non-sterile personnel should always maintain a safe distance from sterile fields.

Question 31: When should the scrub technologist notify the surgeon of a count discrepancy?

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

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

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

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 33: The Bookwalter retractor system differs from hand-held retractors because it:

Is used only in minimally invasive procedures
Attaches to the OR table and holds retractors without assistant effort (Correct answer)
Is disposable and used for a single case only
Requires a dedicated assistant to maintain position

Correct answer: Attaches to the OR table and holds retractors without assistant effort

The Bookwalter is a self-retaining retractor system that mounts to the OR table rail, freeing assistants' hands during open abdominal cases.

Question 34: Which position is used for perineal procedures such as hemorrhoidectomy, placing the patient face down with hips flexed?

Jackknife (Kraske) (Correct answer)
Lithotomy
Reverse Trendelenburg
Lateral decubitus

Correct answer: Jackknife (Kraske)

The jackknife (Kraske) position places the patient prone with the hips over the table break, flexing the hips to expose the perineum and anus.

Question 35: When a count discrepancy is identified at wound closure, what is the FIRST action?

Perform a recount of all items (Correct answer)
Request a radiograph immediately
Notify the charge nurse
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 36: The WHO Surgical Safety Checklist is divided into how many phases?

Three (Correct answer)
Five
Two
Four

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

The patient should be positioned in the prone position to distribute weight evenly
Standard OR tables and positioning aids are sufficient for all patients
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)

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 38: When a specimen is sent to pathology as a frozen section, the purpose is to:

Preserve the specimen for permanent histological analysis
Prevent autolysis of tissue during a prolonged procedure
Obtain rapid intraoperative results to guide surgical decision-making (Correct answer)
Confirm the specimen weight for documentation purposes

Correct answer: Obtain rapid intraoperative results to guide surgical decision-making

Frozen section analysis provides rapid histopathological results within 15-20 minutes, allowing the surgeon to make intraoperative decisions such as margin clearance.

Question 39: What circumstances are regarded as warranting a surgical vitrectomy?

Foreign object in the eye
Glaucoma
Both A and B (Correct answer)
Diabetic retinopathy

Correct answer: Both A and B

A surgical vitrectomy is indicated for various conditions affecting the vitreous humor and retina. This includes removing foreign objects from the eye, which can cause significant damage and vision loss. It is also a crucial treatment for complications of diabetic retinopathy, such as vitreous hemorrhage (blood in the vitreous) or retinal detachment, to restore or preserve vision.

Question 40: A sterile package has a small hole in the wrapping. What is the appropriate response?

Cover the hole with sterile tape and use it
Consider the package contaminated and reprocess (Correct answer)
Check expiration date and proceed if not expired
Use it if the indicator has changed color

Correct answer: Consider the package contaminated and reprocess

Any breach in packaging integrity compromises sterility; the item must be considered contaminated and must be reprocessed.

Question 41: A 6-year-old patient is scheduled for a tonsillectomy. According to standard NPO guidelines, what is the minimum fasting period required for solid foods before surgery?

4 hours
2 hours
6 hours
8 hours (Correct answer)

Correct answer: 8 hours

For children 6 months of age or older, the general NPO guideline for solid food is a minimum of 8 hours before surgery to reduce the risk of pulmonary aspiration during anesthesia. Breast milk is typically 4-6 hours, and clear liquids are often allowed up to 2-3 hours before the procedure.

Question 42: How many times are surgical counts typically performed during a standard operative procedure?

Once, at the start
Three to four times — initial, before cavity closure, and at skin closure (Correct answer)
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 43: Which of the following suture materials is absorbable?

Polyglactin (Vicryl) (Correct answer)
Polypropylene (Prolene)
Silk
Nylon (Ethilon)

Correct answer: Polyglactin (Vicryl)

Polyglactin (Vicryl) is a synthetic absorbable suture that is broken down by hydrolysis over approximately 56–70 days.

Question 44: What tool can be utilized to set up a patient for a total hip replacement?

Wilson frame
Beanbag (Correct answer)
Andrews frame
Stirrups

Correct answer: Beanbag

A beanbag positioner is commonly used to set up a patient for a total hip replacement, particularly when the lateral position is required. The beanbag molds around the patient's body when air is evacuated, providing stable and secure support. This helps maintain the desired surgical position and prevents movement during the procedure.

Question 45: Brachial plexus stretch injury in the supine position is most commonly caused by:

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

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

Managing the sterile field and passing instruments (Correct answer)
Monitoring anesthesia levels
Operating the endoscopy equipment from outside the sterile field
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 47: Which preoperative lab value is most critical to review before a patient undergoes general anesthesia?

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

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

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

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 49: A patient is moved to the post-operative ward, and the nurse is informed of their condition. They learn about the patient's history of thrombocytopenia during the report. Which of the following actions should the nurse do to lower the likelihood that this patient may create a blood clot?

Request that the patient stay in bed with a pillow between his or her knees.
To prevent blood clots, give aspirin as a preventative measure.
Tell the patient to keep their legs straight.
Both A and B (Correct answer)

Correct answer: Both A and B

The provided correct answer (Both A and B) is medically incorrect for preventing blood clots (DVT) in a post-operative patient, especially one with thrombocytopenia (low platelets, which increases bleeding risk, not clotting risk). Keeping legs straight or placing a pillow under the knees can actually impede circulation and increase DVT risk. Standard DVT prevention includes early ambulation, leg exercises, and sometimes pharmacological prophylaxis, none of which are reflected in options A or B.

Question 50: The pleural cavity normally contains a small amount of fluid. What is its primary function?

Reducing friction during breathing (Correct answer)
Secreting surfactant
Facilitating gas exchange
Providing nutrients to lung tissue

Correct answer: Reducing friction during breathing

Pleural fluid lubricates the surfaces of the visceral and parietal pleura, reducing friction as the lungs expand and contract during respiration.

Question 51: What is the purpose of a sterility maintenance cover (dust cover) on sterile packages after sterilization?

To re-sterilize the outer wrap after transport
To extend the sterilization date by 6 months
To indicate the sterilization cycle used
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 52: When passing a sharps instrument on the sterile field, the safest technique is:

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

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 53: A surgeon requests epinephrine to be added to a local anesthetic. What is the primary purpose of this combination?

Provide additional analgesia
Prolong duration and reduce systemic absorption (Correct answer)
Increase anesthetic potency
Prevent allergic reaction

Correct answer: Prolong duration and reduce systemic absorption

Epinephrine causes local vasoconstriction, which slows systemic absorption of the local anesthetic, prolonging its duration and reducing toxicity.

Question 54: During the preoperative time-out, a discrepancy is noted between the surgical consent and the procedure listed on the OR schedule. What should occur?

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

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

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

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 56: Which instrument is specifically used to clamp and divide the cystic duct during a laparoscopic cholecystectomy?

Kocher clamp
Hem-o-lok clip applier (Correct answer)
Babcock clamp
Allis clamp

Correct answer: Hem-o-lok clip applier

Hem-o-lok polymer clips are applied to the cystic duct and cystic artery with a clip applier before division during laparoscopic cholecystectomy.

Question 57: Which type of forceps is commonly used to grasp the dura mater during neurosurgical procedures?

Russian forceps
Adson 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 58: What is the recommended temperature range for storing sterile supplies to maintain package integrity?

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

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 59: The ureters enter the bladder at an oblique angle to create a valve-like effect that prevents:

Renal calculi formation
Urinary retention
Vesicoureteral reflux (Correct answer)
Urinary incontinence

Correct answer: Vesicoureteral reflux

The oblique insertion of the ureters through the bladder wall creates a flap valve mechanism that prevents vesicoureteral reflux during micturition.

Question 60: 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?

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

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 61: Which sterilization method is most appropriate for heat-sensitive, moisture-sensitive items such as fiber optic cables?

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

Correct answer: Ethylene oxide (EO) gas

Ethylene oxide gas sterilizes at low temperatures and is safe for heat- and moisture-sensitive items like fiber optic cables.

Question 62: What is the preferred position for breast surgery?

Dorsal Recumbent (Correct answer)
Prone
Lateral
Lithotomy

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

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

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 64: 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)
Stepping around the non-sterile side
Asking the circulator to rearrange the field
Passing front-to-front

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 65: Surgical site marking should be performed by:

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

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 66: When a patient is brought into the PACU, they exhibit snoring breathing patterns and minimal chest expansion. Their oxygen saturations are at 94% and are starting to decline, the nurse observes. What does the nurse do first?

Encourage the sufferer to breathe more deeply. (Correct answer)
Inform the doctor right away.
The patient should be prone.
Open the airway by giving the jaw a shove.

Correct answer: Encourage the sufferer to breathe more deeply.

Snoring breathing patterns and minimal chest expansion in the PACU, especially with declining oxygen saturation, suggest upper airway obstruction or hypoventilation. The initial, least invasive intervention is to encourage the patient to take deeper breaths. This can help clear minor obstructions, improve lung expansion, and increase oxygen intake, potentially resolving the issue before more aggressive interventions are needed.

Question 67: When opening sterile supplies onto the back table, the circulator should:

Peel the package open and drop or present the item without contaminating contents (Correct answer)
Hand the scrub tech the outer wrapper to open at the table
Open the package and set it on the edge of the sterile field
Reach over the sterile field to place items in the center

Correct answer: Peel the package open and drop or present the item without contaminating contents

The circulator peels back the wrapper and either drops the sterile item onto the field or presents it so the scrub tech can remove it, maintaining sterile integrity.

Question 68: When using ethylene oxide (EO) sterilization, why is an aeration period required after the cycle?

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

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 69: The purpose of placing a tourniquet on an extremity during surgery is to:

Create a bloodless operative field to improve visualization (Correct answer)
Prevent nerve conduction during regional anesthesia
Stabilize the limb in correct anatomical position
Reduce postoperative swelling by limiting lymphatic flow

Correct answer: Create a bloodless operative field to improve visualization

A pneumatic tourniquet inflated above systolic blood pressure occludes arterial inflow, creating a bloodless field that enhances visibility and reduces blood loss.

Question 70: Which patient position is most appropriate for a patient undergoing a laparoscopic cholecystectomy?

Supine with reverse Trendelenburg and left lateral tilt (Correct answer)
Prone with arms extended overhead
Lithotomy with steep Trendelenburg
Lateral decubitus with axillary roll

Correct answer: Supine with reverse Trendelenburg and left lateral tilt

Reverse Trendelenburg with left lateral tilt shifts abdominal organs away from the operative field, improving visualization of the gallbladder during laparoscopic cholecystectomy.

Question 71: What anatomical structure must always be preserved during a cholecystectomy?

Cystic artery
Cystic duct
Cystic vein
Common duct (Correct answer)

Correct answer: Common duct

During a cholecystectomy (gallbladder removal), it is absolutely critical to identify and preserve the common bile duct. This duct carries bile from the liver to the small intestine, and accidental injury to it can lead to severe complications such as bile leakage, strictures, and liver damage. Careful dissection and identification are paramount to avoid this.

Question 72: Which type of wound closure uses staples or sutures placed through all layers of the abdominal wall?

Secondary closure
Primary closure
Retention (tension) sutures (Correct answer)
Delayed primary closure

Correct answer: Retention (tension) sutures

Retention (tension) sutures are large sutures placed through all layers of the abdominal wall to prevent wound dehiscence in high-risk patients.

Question 73: Which instrument is used to cut through the sternum during a median sternotomy?

Lebsche sternal knife (Correct answer)
Oscillating saw
Stryker saw
Sternal saw (Satterlee)

Correct answer: Lebsche sternal knife

The Lebsche sternal knife, used with a mallet, is specifically designed to split the sternum longitudinally during median sternotomy.

Question 74: When attempting to interview a patient with a language barrier but no interpreter is available, which of the following should the nurse do?

Act out some words while saying them to facilitate better understanding (Correct answer)
When an interpreter is there, refrain from speaking to the patient
Speak slowly and loudly to make sure the patient can hear you
Avoid using well-known words in the patient's native tongue if pronounced improperly

Correct answer: Act out some words while saying them to facilitate better understanding

When an interpreter is unavailable for a patient with a language barrier, acting out some words while saying them (using gestures and pantomime) can significantly facilitate understanding. This non-verbal communication can bridge the language gap by providing visual cues that reinforce the spoken words. While not a substitute for a professional interpreter, it can be a helpful temporary strategy to convey basic information and assess immediate needs.

Question 75: Which nerve is most at risk for compression injury from stirrups in the lithotomy position?

Femoral nerve
Ulnar nerve
Radial nerve
Common peroneal nerve (Correct answer)

Correct answer: Common peroneal nerve

The common peroneal nerve wraps around the lateral fibular head and is vulnerable to direct stirrup pressure, causing foot drop if injured.

Question 76: What does the 'size' designation of a suture (e.g., 2-0, 4-0) indicate?

Estimated absorption time in days
Tensile strength in newtons
Diameter of the suture material (Correct answer)
Length of the suture strand

Correct answer: Diameter of the suture material

Suture size refers to the diameter of the strand; higher numbers after a dash (e.g., 4-0) indicate smaller diameter sutures.

Question 77: What three elements does the surgical 'time-out' verify before incision?

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

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

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 79: What does the term 'strike-through contamination' mean in the context of surgical draping?

A needle penetrating a drape
Moisture soaking through a drape compromising sterility (Correct answer)
A drape falling off the sterile field
Air contaminating the sterile field through a torn drape

Correct answer: Moisture soaking through a drape compromising sterility

Strike-through contamination occurs when moisture wicks through a drape, providing a path for microorganisms to reach the sterile field.

Question 80: Where are Baker's cysts found?

popliteal fossa (Correct answer)
webbed fingers
10 minutes
surgically clean

Correct answer: popliteal fossa

A Baker's cyst, also medically known as a popliteal cyst, is a fluid-filled sac that causes a bulge and a feeling of tightness behind the knee. It is named after the popliteal fossa, which is the anatomical space located at the back of the knee joint where these cysts typically form. The cyst is usually a result of fluid accumulation from the knee joint.

Question 81: During a surgical count, a discrepancy is found. The correct sequence of actions is to:

Proceed with closure and document the discrepancy
Notify the charge nurse after the case
Inform the surgeon immediately and search the wound before closing (Correct answer)
Complete the count again and close if the second count agrees

Correct answer: Inform the surgeon immediately and search the wound before closing

An immediate count discrepancy requires notifying the surgeon so the wound can be searched before closure to prevent a retained surgical item.

Question 82: 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?

Remove the outer wrap and inspect the inner wrap before deciding to use the tray.
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)

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 83: Which of the following is the strongest against sterilizing techniques?

Tubercle bacillus
Virus
Spore (Correct answer)
Spirochete

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

Ileocolostomy (Correct answer)
Colorectal anastomosis
Jejuno-jejunostomy
Esophagogastrostomy

Correct answer: Ileocolostomy

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

Question 85: An incorrect count at skin closure requires which actions?

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

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 86: 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
Reaches below the level of the sterile drape to retrieve a fallen item (Correct answer)
Faces the sterile field while moving around the table

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

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

Correct answer: Geobacillus stearothermophilus

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

Question 88: The parathyroid hormone controls

Calcium (Correct answer)
Sodium
Bicarbonate
Protein

Correct answer: Calcium

The parathyroid hormone (PTH), secreted by the parathyroid glands, is the primary regulator of calcium and phosphate levels in the blood. PTH increases blood calcium levels by stimulating calcium release from bones, increasing calcium reabsorption in the kidneys, and promoting vitamin D activation, which enhances intestinal calcium absorption. Maintaining proper calcium balance is vital for bone health, nerve function, and muscle contraction.

Question 89: Which type of wound healing occurs when wound edges are approximated and closed primarily with sutures?

Healing by secondary intention
Healing by tertiary intention
Healing by primary intention (Correct answer)
Granulation healing

Correct answer: Healing by primary intention

Primary intention healing occurs when clean wound edges are surgically approximated, minimizing scar formation and healing time.

Question 90: What type of surgery is used to treat a condition where the urethral meatus is located on the upper surface of the penis?

spinal stenosis
reverse trendelenburg
incident report
epispadias repair (Correct answer)

Correct answer: epispadias repair

Epispadias is a congenital birth defect where the urethra, the tube that carries urine out of the body, does not fully form into a tube and its opening (meatus) is located on the upper (dorsal) surface of the penis. An epispadias repair is the specific surgical procedure designed to correct this anatomical abnormality, reconstructing the urethra and repositioning the meatus to its correct location.

Question 91: 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?

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)
Tell the patient they must lie flat for the next hour while you lower the bed's head

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

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

Correct answer: Arm, fingers to shoulder

For an Open Reduction Internal Fixation (ORIF) of the humerus, the surgical preparation area must be extensive to ensure a sterile field and allow for full manipulation of the limb. Therefore, the entire arm, from the fingertips up to the shoulder, is prepped. This provides ample sterile working space for the surgeon.

Question 93: Which cranial nerve is solely responsible for the sense of smell and is designated as CN I?

Olfactory Nerve (CN I) (Correct answer)
Optic Nerve (CN II)
Trigeminal Nerve (CN V)
Facial Nerve (CN VII)

Correct answer: Olfactory Nerve (CN I)

The Olfactory Nerve, or Cranial Nerve I (CN I), is a sensory nerve that transmits information relating to the sense of smell from the nasal cavity to the brain.

Question 94: The Circle of Willis provides collateral cerebral circulation. Which vessel is NOT a component of the Circle of Willis?

Anterior communicating artery
Basilar artery
Posterior communicating artery
Middle cerebral artery (Correct answer)

Correct answer: Middle cerebral artery

The middle cerebral artery branches off the internal carotid but is not part of the Circle of Willis itself, which includes the communicating arteries and their connecting vessels.

Question 95: Skin staples used for wound closure are primarily composed of:

Absorbable polymer
Chrome-cobalt alloy
Stainless steel (Correct answer)
Titanium alloy

Correct answer: Stainless steel

Standard surgical skin staples are made of stainless steel, which is biocompatible, strong, and causes minimal tissue reaction.

Question 96: Which preoperative action helps reduce the risk of hypothermia during surgery?

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

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 97: During a laparotomy, the surgeon requests irrigation. The surgical technologist has 1,000 mL of sterile normal saline on the back table. After pouring some into a basin, 300 mL remains in the original bottle. The surgeon uses an unmeasured amount from the basin. Later, the circulator adds another 500 mL to the back table supply. At the end of the case, 600 mL is left on the back table. How much irrigation was used?

700 mL
400 mL
900 mL (Correct answer)
1,100 mL

Correct answer: 900 mL

To calculate the amount of irrigation used, track the total amount delivered to the sterile field and subtract the amount remaining. Initial amount: 1,000 mL. Added amount: 500 mL. Total on field: 1,000 + 500 = 1,500 mL. Amount remaining: 600 mL. Amount used: 1,500 mL (total) - 600 mL (remaining) = 900 mL.

Question 98: During a cesarean section, the scrub tech should anticipate having a bulb syringe available primarily to:

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

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 99: What is the term for the minimum alveolar concentration (MAC) of an inhaled anesthetic?

The alveolar concentration preventing movement in 50% of patients to skin incision (Correct answer)
The maximum safe inhaled dose
The concentration causing loss of consciousness
The concentration that blocks all sensory input

Correct answer: The alveolar concentration preventing movement in 50% of patients to skin incision

MAC is defined as the minimum alveolar concentration of an anesthetic at which 50% of patients do not move in response to a standard surgical stimulus (skin incision).

Question 100: Which opioid is known to cause histamine release, resulting in hypotension, bronchospasm, and pruritus when given rapidly IV?

Remifentanil
Morphine (Correct answer)
Fentanyl
Sufentanil

Correct answer: Morphine

Morphine causes histamine release from mast cells, which can precipitate bronchospasm, hypotension, and pruritus, especially with rapid intravenous administration.

Question 101: Which of the following is the electrosurgical unit's active electrode?

Pencil (Correct answer)
Voltage intensity dial
Wall plug
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 102: Which opioid analgesic is most commonly administered intraoperatively as a continuous infusion due to its rapid onset and titrability?

Morphine
Codeine
Remifentanil (Correct answer)
Meperidine

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

Interspersed randomly throughout the load
Horizontally on the top shelf
On top of lighter items
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 104: The CUSA (Cavitron Ultrasonic Surgical Aspirator) is used primarily for:

Cutting bone with ultrasonic vibration
Irrigating the surgical field
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 105: Wound dehiscence is defined as:

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

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 106: Which of the following must the nurse make sure the patient understands before the fiberoptic colonoscopy?

For a week previous to the procedure, the patient should consume less fluid.
Before the surgery, the patient must go at least 12 hours without eating.
After the lavage solution has been infused, the patient may continue taking regular medications, with the exception of anticoagulants.
It is possible to consume the lavage solution orally or via nasogastric tube. (Correct answer)

Correct answer: It is possible to consume the lavage solution orally or via nasogastric tube.

Explanation: The lavage fluid may be consumed orally or through a nasogastric tube, which the nurse must explain to the patient before the fiberoptic colonoscopy. In order for the doctor to see the interior structures while doing the treatment, this fluid cleans and prepares the bowel. Following the cleansing solution, the patient usually needs to stop taking all medications, and they might need to drink less water for one to two days prior to the surgery.

Question 107: What should be done with equipment that are difficult to clean after being used on a person who has Creutzfeldt-Jakob disease?

For 90 minutes, submerge the instruments in a closed container of sodium oxalate.
As directed, wash and sanitize the tools, but store them apart from other instruments.
Use a steam autoclave to start the decontamination process. (Correct answer)
The instruments should be submerged in formaldehyde for around 30 minutes before beginning the disinfecting procedure.

Correct answer: Use a steam autoclave to start the decontamination process.

Explanation: The nurse should start decontamination by using a steam autoclave when handling devices that are difficult to clean after being used on a patient with Creutzfeldt-Jakob disease. This lethal condition can spread between patients via surgical tools. The prion that is linked to this illness is exceedingly difficult to remove using traditional sterilization techniques, and if the right protocol is not followed, it could even become more fixed to infected devices.

Question 108: 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?

XII (hypoglossal) (Correct answer)
VII (facial)
V (trigeminal)
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 109: When positioning a patient prone, which device is essential to prevent pressure on the chest and abdomen while allowing adequate ventilation?

Chest rolls or a prone positioning frame (Correct answer)
Mayfield skull clamp
Kidney rest
Allen stirrups

Correct answer: Chest rolls or a prone positioning frame

Chest rolls or a prone frame elevate the thorax and abdomen off the table, protecting female breasts, preventing abdominal compression, and allowing diaphragmatic excursion.

Question 110: Which of the following packaging materials is NOT acceptable for steam sterilization?

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

Correct answer: Aluminum foil

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

Question 111: What position is typically used for hemorrhoidectomy?

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

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 112: Which of the following is utilized by the surgeon during a TURP to periodically remove prostatic tissue fragments?

gram stain
ellik evacuator (Correct answer)
anesthesia provider
full thickness

Correct answer: ellik evacuator

During a Transurethral Resection of the Prostate (TURP), prostatic tissue is resected and fragments are created. The Ellik evacuator is a specialized instrument used to irrigate the bladder and suction out these resected prostatic tissue fragments and blood clots. Its design allows for efficient removal of debris, maintaining a clear surgical field and preventing obstruction.

Question 113: A sterile field has been set up and left unattended for 30 minutes. What is the correct action?

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

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 114: When a surgeon requests a 'figure-of-eight' suture pattern, the primary purpose is:

To close skin edges with minimal tension
To create a subcuticular buried closure for cosmesis
To close tubular structures such as blood vessels
To provide additional strength and distribute tension at high-stress closure sites (Correct answer)

Correct answer: To provide additional strength and distribute tension at high-stress closure sites

A figure-of-eight suture distributes tension across a wider tissue area, providing reinforced closure at high-stress sites such as fascia or tendon repair.

Question 115: Which of the following is a depolarizing neuromuscular blocking agent characterized by a rapid onset and very short duration of action, often used for endotracheal intubation?

Vecuronium (Norcuron)
Rocuronium (Zemuron)
Succinylcholine (Anectine) (Correct answer)
Pancuronium (Pavulon)

Correct answer: Succinylcholine (Anectine)

Succinylcholine is the only depolarizing neuromuscular blocker in common clinical use. It works by binding to acetylcholine receptors, causing initial muscle fasciculations followed by paralysis. Its rapid onset and short duration make it ideal for facilitating rapid sequence intubation.

Question 116: 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)
Apply sterile drape over the sleeve
Rinse the sleeve with sterile saline

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

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

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 118: When preparing a patient for surgery with a known Foley catheter in place, what must the surgical technologist verify?

That the catheter is patent and draining freely before positioning (Correct answer)
That the catheter balloon is deflated before transport to the OR
That the drainage bag is positioned above bladder level
That the catheter is clamped to prevent urine loss

Correct answer: That the catheter is patent and draining freely before positioning

Verifying catheter patency and free drainage before positioning prevents bladder distention, which can complicate surgery and harm the patient.

Question 119: In OR fire prevention, the 'fire triangle' consists of an ignition source, an oxidizer, and:

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

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

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

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 121: What surgical technique is preferred for breast surgery?

Lateral
Dorsal Recumbent (Correct answer)
Prone
Lithotomy

Correct answer: Dorsal Recumbent

The dorsal recumbent position, also known as supine, is generally preferred for most breast surgeries, including biopsies, lumpectomies, and mastectomies. In this position, the patient lies flat on their back, allowing for optimal exposure of the chest and breast area. This provides the surgeon with clear access and facilitates proper draping and positioning for the procedure.

Question 122: Where should a patient be placed for a temporal craniectomy by the perioperative nurse?

Supine
Sitting (Correct answer)
Lateral recumbent
Prone

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

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

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

Urinary retention
Deep vein thrombosis
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 125: A patient is scheduled for a left knee arthroscopy. According to the Universal Protocol, which action is most critical for preventing wrong-site surgery?

Verifying the patient's name and date of birth.
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)
Confirming the procedure with the circulating nurse.

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 126: During a craniotomy, bone wax is used to:

Secure the bone flap in place after closure
Control bleeding from cancellous bone of the skull (Correct answer)
Prevent cerebrospinal fluid leakage
Reduce brain swelling during the procedure

Correct answer: Control bleeding from cancellous bone of the skull

Bone wax is a hemostatic agent packed into bleeding diploë (cancellous bone) of the skull to mechanically tamponade hemorrhage.

Question 127: 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?

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

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 128: 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.
A chemical indicator strip inside the pack has changed to the correct color.
The printout from the sterilizer shows all physical parameters were met.

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 129: Which instrument is used to hold a needle securely for suturing deep in a cavity?

Castro-Viejo needle holder
Heaney needle holder (Correct answer)
Ryder needle holder
Crile-Wood needle holder

Correct answer: Heaney needle holder

The Heaney needle holder has a curved jaw designed specifically for suturing in deep pelvic and vaginal cavities where straight instruments cannot reach effectively.

Question 130: A 'raytec' sponge is most commonly used in surgery to:

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

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 131: What microbes can survive without oxygen?

anaerobes (Correct answer)
third
subluxation
compound

Correct answer: anaerobes

Anaerobes are microorganisms that do not require oxygen for growth and can even be harmed by its presence. They obtain energy through anaerobic respiration or fermentation, processes that do not utilize oxygen. In contrast, aerobes require oxygen, and facultative anaerobes can grow with or without it.

Question 132: Which term describes the process of transferring microorganisms from one surface to another via an intermediate object?

Direct contact transmission
Airborne transmission
Indirect contact transmission (Correct answer)
Droplet transmission

Correct answer: Indirect contact transmission

Indirect contact transmission occurs when microorganisms transfer via a contaminated intermediate object (fomite) rather than direct person-to-person contact.

Question 133: X-ray detectable sponges are used in surgery primarily to:

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

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 134: On a ring-handled instrument, such as a hemostat or needle driver, what is the name of the interlocking mechanism that holds the jaws in a closed position?

Shank
Box lock
Ratchet (Correct answer)
Jaw

Correct answer: Ratchet

The ratchet is the component with interlocking teeth located on the shanks of the instrument, which allows it to be locked at various degrees of pressure. [7, 16] The box lock is the hinge, the shank is the body, and the jaws are the working tips of the instrument.

Question 135: During preoperative patient identification, which of the following methods is considered the most reliable practice according to WHO guidelines?

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

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 136: 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
Diarrhea is more likely to strike the sufferer
Postoperative bleeding is more likely to occur in the patient
An infection is more prone to spread to the patient (Correct answer)

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

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

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 138: Which position places the patient flat on their back with arms extended on armboards?

Supine (Correct answer)
Lateral decubitus
Lithotomy
Prone

Correct answer: Supine

The supine position is the standard flat-on-the-back position used for most abdominal, thoracic, and extremity procedures.

Question 139: The Trendelenburg position places the patient:

Supine with the head elevated 30–45 degrees
On their side with the operative side up
Prone with the head turned to the side
Supine with the head tilted downward and feet elevated (Correct answer)

Correct answer: Supine with the head tilted downward and feet elevated

Trendelenburg position is supine with the head down and feet up, commonly used for lower abdominal and pelvic surgeries.

Question 140: Which items are included in a complete surgical count per AORN standards?

Instruments only
Sponges only
Sponges, sharps, and instruments (Correct answer)
Sharps and 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 141: What is the name of the urinary catheter used on urethral stricture patients that has a narrow, curved, tapered tip?

acute
55-60
laser
coude (Correct answer)

Correct answer: coude

A Coude catheter is a type of urinary catheter characterized by its curved, tapered tip. This specific design makes it easier to navigate past obstructions in the urethra, such as an enlarged prostate or urethral strictures. It is particularly useful for patients who might experience difficulty with the insertion of a standard straight catheter.

Question 142: Which instrument is used to grasp and manipulate the intestine without crushing the tissue?

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

Correct answer: Babcock forceps

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

Question 143: Which anesthesia type allows the patient to remain conscious while a specific body region is numbed?

Regional anesthesia (Correct answer)
Moderate sedation
Inhalation anesthesia
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 144: Which of the following is the correct technique for verifying patient identity in the preoperative area?

Ask the patient their room number and confirm it matches the chart
Accept verbal confirmation from the transporter who brought the patient
Use two patient identifiers such as name and date of birth, confirmed verbally and with the wristband (Correct answer)
Check the patient's face against the photo in the electronic record only

Correct answer: Use two patient identifiers such as name and date of birth, confirmed verbally and with the wristband

Two independent patient identifiers (e.g., full name and date of birth) confirmed verbally and matched to the wristband are required per Joint Commission National Patient Safety Goals.

Question 145: When passing a sharp instrument during surgery, the BEST method to maintain safety and sterility is:

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

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 146: Which OSHA standard specifically governs occupational exposure to bloodborne pathogens in the surgical setting?

29 CFR 1910.1200 (Hazard Communication)
29 CFR 1910.147 (Lockout/Tagout)
29 CFR 1910.132 (Personal Protective Equipment)
29 CFR 1910.1030 (Bloodborne Pathogens Standard) (Correct answer)

Correct answer: 29 CFR 1910.1030 (Bloodborne Pathogens Standard)

OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) requires engineering controls, PPE, and exposure plans to protect workers from blood and body fluids.

Question 147: Which inhaled anesthetic agent is known to trigger malignant hyperthermia in susceptible patients?

Sevoflurane (Correct answer)
Nitrous oxide
Xenon
Halothane

Correct answer: Sevoflurane

Sevoflurane, like all volatile halogenated agents, can trigger malignant hyperthermia in genetically susceptible individuals through abnormal RYR1 receptor activation.

Question 148: A Jackson-Pratt (JP) drain maintains drainage by:

Passive gravity flow
Continuous wall suction
Positive pressure from a pump
Negative pressure created by compressing the bulb reservoir (Correct answer)

Correct answer: Negative pressure created by compressing the bulb reservoir

The Jackson-Pratt drain uses a collapsible bulb that creates low-level negative pressure (suction) when compressed and reconnected to the drain tubing.

Question 149: A patient is undergoing a repair of the rotator cuff. Which of the following muscles is NOT part of this functional group?

Supraspinatus
Subscapularis
Teres minor
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 150: 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
That decision is made by the surgeon and you can ask them directly (Correct answer)
Tourniquets are required by law for all orthopedic procedures
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 151: During a laparoscopic procedure, the surgeon requests insufflation. Which gas is most commonly used?

Oxygen
Carbon dioxide (Correct answer)
Nitrous oxide
Nitrogen

Correct answer: Carbon dioxide

Carbon dioxide is used for laparoscopic insufflation because it is readily absorbed by the body and does not support combustion.

Question 152: Which surgical position is most commonly used for procedures on the spine, buttocks, and posterior lower extremities?

Supine
Fowler's (sitting)
Lateral (lateral decubitus)
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 153: During a craniotomy, which instrument is used to elevate the bone flap?

Gigli saw
Leksell rongeur
Craniotome (perforator) (Correct answer)
Penfield dissector

Correct answer: Craniotome (perforator)

A craniotome (perforator) drills burr holes in the skull, which are then connected to allow the bone flap to be elevated during craniotomy.

Question 154: Which of the following tests evaluates fibrinogen and the clotting factors V, VII, and X to determine coagulation?

Platelet aggregation
Prothrombin time (Correct answer)
Partial thromboplastin time
Reticulocyte count

Correct answer: Prothrombin time

Explanation: The prothrombin time test evaluates fibrinogen and clotting factors V, VII, and X to determine coagulation. The results of this kind of test can be used to assess clotting potential, the effectiveness of specific medications, and surgical risk factors in at-risk patients. Depending on the treatment, the patient with reduced coagulation may need to have surgery delayed.

Question 155: What is the correct chlorhexidine gluconate (CHG) skin prep technique for a patient with iodine sensitivity?

Use povidone-iodine but apply it in smaller amounts
Use only sterile saline for patients with iodine allergies
No skin preparation is needed if the patient is allergic to iodine
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 156: Methicillin-resistant Staphylococcus aureus (MRSA) is best prevented in the OR through:

Contact precautions and strict hand hygiene (Correct answer)
Laminar airflow systems alone
High-level disinfection of all surfaces between cases
Routine antibiotic prophylaxis for all patients

Correct answer: Contact precautions and strict hand hygiene

Contact precautions including gown, gloves, and rigorous hand hygiene are the cornerstone of MRSA prevention in the surgical environment.

Question 157: The nurse is performing a preoperative assessment on a patient and notes that they have a heart murmur. When assessing intensity of a cardiac murmur, what question should the nurse ask themself?

Are there any more sounds made by the murmur?
When does the murmur happen—diastole or systole?
Where exactly on the chest is the murmur audible?
How loud is the murmur? (Correct answer)

Correct answer: How loud is the murmur?

Explanation: The nurse should ask themselves, "How loud is the murmur?" when determining the strength of a heart murmur. The murmur's volume is measured by intensity, which is normally graded from a very quiet grade I murmur to a loud grade VI murmur. By auscultating with a stethoscope, the nurse can determine the severity of the murmur and can then inform the doctor of their findings.

Question 158: Which hemostatic agent is derived from oxidized cellulose and works by creating an artificial clot?

Gelfoam (gelatin sponge)
Thrombin
Bone wax
Surgicel (oxidized regenerated cellulose) (Correct answer)

Correct answer: Surgicel (oxidized regenerated cellulose)

Surgicel is made from oxidized regenerated cellulose that lowers pH and denatures blood proteins, creating a coagulum that promotes hemostasis.

Question 159: The term 'counts' in the OR refers to:

Counting the number of suture packets opened
Tracking the number of surgical team members present
Recording the amount of irrigation fluid used
Reconciling sponges, sharps, and instruments before wound closure (Correct answer)

Correct answer: Reconciling sponges, sharps, and instruments before wound closure

Counts involve reconciling sponges, sharps, and instruments at specific intervals to prevent retained surgical items.

Question 160: During a laparoscopic procedure, CO2 insufflation pressure is typically maintained at:

20–25 mmHg
5–8 mmHg
10–15 mmHg (Correct answer)
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 161: Which of the following best describes the surgical technologist's responsibility regarding the preoperative count?

Counts are optional for procedures lasting less than 30 minutes
Only sponges are counted preoperatively; instruments are counted intraoperatively
Counts are performed only by the circulating nurse
The scrub tech and circulator count together audibly before the procedure begins (Correct answer)

Correct answer: The scrub tech and circulator count together audibly before the procedure begins

The scrub technologist and circulating nurse perform an audible concurrent count of all sponges, sharps, and instruments before the procedure to establish a baseline.

Question 162: A patient undergoing thyroid surgery is placed in which specialized position to improve surgical access?

Lateral decubitus with bean bag
Trendelenburg with arms tucked
Prone jackknife
Supine with neck hyperextended using a shoulder roll (Correct answer)

Correct answer: Supine with neck hyperextended using a shoulder roll

Placing a shoulder roll under the patient's shoulders extends the neck, elevating and exposing the thyroid gland for optimal surgical access.

Question 163: The scrub technologist is preparing heparin for a vascular procedure. What is the antidote if heparin-induced bleeding occurs?

Vitamin K
Tranexamic acid
Fresh frozen plasma
Protamine sulfate (Correct answer)

Correct answer: Protamine sulfate

Protamine sulfate neutralizes heparin by forming a stable ion pair complex, reversing its anticoagulant effect.

Question 164: 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?
Is the patient allergic to shellfish? (Correct answer)
Does the patient have high blood pressure?

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

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

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

Wipe it with a sterile towel and pass it to the surgeon
Flash sterilize it only if it will be used on intact tissue
Refuse to provide it until proper sterilization is complete (Correct answer)
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 167: Which instrument would the scrub tech most likely hand the surgeon to grasp and cut the cystic duct during a laparoscopic cholecystectomy?

LigaSure vessel-sealing device and straight hemostat
Harmonic scalpel and Babcock clamp
Laparoscopic clip applier and laparoscopic scissors (Correct answer)
Curved Mayo scissors and Kelly clamp

Correct answer: Laparoscopic clip applier and laparoscopic scissors

During laparoscopic cholecystectomy, clips are applied to the cystic duct with a clip applier, and laparoscopic scissors are used to divide it between the clips.

Question 168: During a craniotomy, the surgeon requires a self-retaining retractor system that can be fixed to the skull and uses flexible arms to gently retract delicate brain tissue. Which of the following retractors would be appropriate?

Balfour retractor
Weitlaner retractor
Leyla-Yasargil retractor (Correct answer)
Bookwalter retractor

Correct answer: Leyla-Yasargil retractor

The Leyla-Yasargil retractor is a specialized, self-retaining brain retractor used in neurosurgery. [9, 10] It attaches to a fixation base on the skull and uses flexible arms to hold brain spatulas for gentle retraction. [4, 18] The Balfour, Bookwalter, and Weitlaner retractors are used for abdominal, pelvic, or general surgery. [6, 15]

Question 169: 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?

Immerse the handpiece and attachments in an enzymatic soak.
Disassemble the components and wipe them down, keeping the power unit/cable connections dry. (Correct answer)
Place the entire assembly in an ultrasonic cleaner to loosen bioburden.
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 170: Which preoperative finding would most likely require postponement of an elective surgical procedure?

A patient with a BMI of 28
A patient with a history of seasonal allergies
A patient with a potassium level of 2.8 mEq/L (Correct answer)
A patient with controlled hypertension on medication

Correct answer: A patient with a potassium level of 2.8 mEq/L

Hypokalemia (K+ < 3.0 mEq/L) increases the risk of cardiac dysrhythmias during anesthesia and is a common reason to postpone elective surgery.

Question 171: If a sponge is added to the sterile field AFTER the initial count, what must occur?

No action is needed until the closing count
The added sponge must be counted and included in the running total (Correct answer)
A new count sheet must be started from zero
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 172: Which flash (IUSS) sterilization cycle parameter is correct for unwrapped, non-porous metal instruments in a pre-vacuum sterilizer?

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

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.

Question 173: Which sterilization method is most appropriate for heat-sensitive instruments such as fiber-optic scopes?

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

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 174: 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.
Explaining the risks and benefits of the procedure to the patient.
Determining if the patient is mentally competent to sign the consent.
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 175: Which one of the following constitutes a high-level disinfection technique?

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

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

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

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.

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

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150 min

Time Limit

70%

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