Preliminary Exam Questions with correct answers 2024

During a colon resection, an endo GIA misfired. Where should the surgical technologist bring the endo GIA after surgery? - answer-Decontamination area Rationale: The endo GIA was opened during the colon resection so it is considered unsterile and contaminated. It would need to go to the decontamination area. Material management is where supplies for the hospital are kept. Central processing department is where instruments are put together and re-processed for use. When preparing peel pack instruments for steam sterilization the surgical technologist should inspect the instrument, place an indicator in the package, and - answer-label the package. Rationale: The last thing that needs to be done to the package is to label the contents. It is being steam sterilized so it does not need a Sterrad indicator. Since it is in a peel pack it does not need a biological indicator. The steam sterilizer temperature is already set. The surgical technologist places the patient in Fowler position with head secured by craniotomy headrest. Which of the following locations indicates correct application of the safety strap? - answer-2 inches above the knees Rationale: Correct placement of the safety strap is two inches above the knees. Take care to make sure the strap is not too tight. You should be able to slip two fingers under the strap with ease. Placing the strap across the torso would not secure the legs to the bed. Placing the strap below the knees does not provide adequate safety support to the rest of the body. When assembling instruments for sterilization, the surgical technologist should place instruments on the stringer with - answer-clamps in the open position. Rationale: Maintain instruments in open position during sterilization process. This allows the steam heat or chemicals to reach the interior of the locking mechanism and jaws of the instrument, that might not be accessible if the clamps are closed. During an abdominal surgery, the anesthetist states that they believe an MH crisis is presenting itself in the surgical patient. The surgical tech should - answer-Prepare to close quickly and maintain the sterile field Rationale: The surgical tech should maintain the sterile field and be prepared for any surgical needs that may need to be addressed once the MH crisis is averted. Which of the following must the surgical technologist verify before implants are opened during a total knee replacement? (Select the three (3) correct answers.) - answer-Expiration date, Name of component, Size Rationale: Manufacturer name and lot number do not have to be verified by the surgical technologist, but are charted by the circulator for documentation. Always verify implant type, size, and expiration date, prior to opening. While working on an open bowel procedure and the surgical technologist notices the small bowel is starting to dry out. Which of the following should the technologist do? - answer-Use saline soaked laparotomy sponges to moisten the bowel. Rationale: The status of the patient's tissues should be continuously monitored. To prevent tissue from drying, normal saline is applied throughout the procedure. Any time tissue is exposed to air, drying can occur. The surgical technologist should dampen the tissue to avoid this. Sterile water would not be used because it is considered hypotonic which would cause the cells to swell and rupture. Humidity levels should stay between 30-60% because a higher humidity can dampen materials, supporting bacterial growth. When reviewing the autoclave log, the surgical technologist should confirm that which of the following have been documented before using the instrumentation? - answer-Exposure temperature Rationale: Exposure temperature is one of the items of documentation that should be on the monitoring log. This will allow the ST to see if the sterilizer has reached the required temperature to deem the item or tray sterile. After a resident connects the Yankauer suction tip, it falls slightly below the edge of the sterile field. Which of the following should be considered contaminated? - answer-Yankauer suction tip Rationale: Anything below the level of the sterile field is considered unsterile. When the tip of the Yankauer falls below the edge of the sterile field, it is considered contaminated. Unless it comes in contact with the drapes, or the residents gown as it's being passed off - it would be all that is considered contaminated. Which of the following prep solutions is contraindicated for use with a laser? - answer-Duraprep Rationale: Duraprep contains alcohol and should not be used with lasers to prevent surgical fires. If it hasn't dried for 3 minutes or pools, it has the potential to start a surgical fire. Iodophors, Hibiclens and triclosan do not contain alcohol and are not likely to start a fire. When moving a conscious patient from a stretcher to the operating table, which of the following should the surgical technologist do first? - answer-Align the stretcher and operating table and lock the wheels. Rationale: Before a patient is moved from one bed to another, always make sure the beds are lined up together, closing any gap between the two beds, and then lock the wheels of the bed in place. Only after that has happened can you ask a patient if they are able to move over and ensure IV lines and catheters are free. Asking the patient to move before the bed is aligned and wheels locked may result in the patient falling off the bed. You can untie the patients gown after they have moved over. Ten minutes into an automatic chemical washer cycle for an instrument string, the surgical technologist notices she has missed a few critical instruments. Which of the following should the technologist do? - answer-Wait until the washer stops and run a new cycle with the instruments. Rationale: The correct thing to do is wait until the cycle stops then add the instruments and start a new cycle. The instruments should not be added to the stringer until they have gone through the washer sterilizer. It is not good to abort the cycle. Which of the following is a correct date notation for a sterile package? - answer-164 Rationale: "164" is the Julian date which indicates the date of sterilization. The Julian date is the number of the calendar day (1-365/366). Which of the following instruments is used to extend the arteriotomy during a carotid endarterectomy? - answer-Potts-Smith Rationale: Potts-Smith scissors are delicate scissors used to extend an opening to an artery or vein and they can cut through calcified plaque. They are angled to be able to make a better cut. The straight Mayo and Jorgenson scissors are heavier scissors and would not be appropriate to cut veins and arteries. Stevens tenotomy scissors are used to cut and dissect delicate tissue such as in vascular, plastics or eyes. The surgical technologist reviews the schedule for the following day and notices that an orthopedic surgeon has scheduled an ACL reconstruction with donor graft. Which of the following tissue implants is the correct term describing this graft? - answer-Allograft Rationale: An allograft is taken from another person or cadaver. An autograft is taken from the patient's own tissue. Dermal and epidermal both refer to skin grafts. The anesthesia care provider (ACP) is performing an induction on a known asthmatic patient. The patient experiences a laryngospasm during intubation. The patient's oxygen saturation is 65%. The scrubbed surgical technologist should - answer-prepare for a tracheostomy. Rationale: The asthmatic patient had difficulty breathing when intubated and the oxygen saturation dropped. To support airway management, it would be necessary to set up for a tracheostomy. The surgical technologist would not prepare the machine or hold cricoid pressure due to it is not in their scope of practice. A laryngoscopy would not aid in air way management. The surgical technologist is scrubbed in on a scheduled breast biopsy with a frozen section. After removing the specimen, the surgeon tags the specimen with suture at 6 o'clock and passes it to the technologist. Which of the following should the technologist do first? - answer-Ask the surgeon to identify the specimen. Rationale: The specimen must always be verified by the surgeon before being passed off. Patient labels will be placed in the sterile, dry, container after verification and the specimen will be passed off to the circulator to be transported to the lab immediately. Specimens should never be placed on sponges. During a case a surgical technologist's relief comes into the OR just as the surgeon announces a bleeding problem with the patient. Which of the following should the surgical technologist do? - answer-Ask the relief to wait until the surgeon gives permission, and then do a count of sharps, sponges, needles. Rationale: In a patient critical situation, before a break or relief should be given, the patient should be stable and the surgeon should give approval for the current surgical technologist to leave. Once permission is given, a count of sharps and sponges should be completed by the current ST. In anticipation of a visually impaired patient's surgical procedure, the best practice in facilitating movement would be for the surgical technologist to - answer-explain the process of moving from stretcher to bed then guide the patient's hand to aid him while he moves. Rationale: Since the patient is visually impaired they cannot see that well what you are telling them to do. Someone should explain to the patient, what will be needed from them to move over to the operating room bed. The surgical technologist should guide the patient's hand and tell them where it is expected for them to move. The patient should be told what to do first ,and then have them move over to the correct position, with guidance as they move. During the procedure, the ESU malfunctioned causing injury to the patient. Which of the following documentation needs completed following the case? - answer-incident report Rationale: Any adverse patient incident must be reported by completing an incident report or a sentinel event report. These are used to identify potential factors that caused the issue as well as to prevent it from happening in the future. An advanced directive is a written documentation that expresses a patient's wishes about their medical treatment. A complaint is considered the first pleading filed by a plaintiff in a case of negligence. An informed consent is a required written consent to surgery that is signed by the surgeon and patient prior to surgery. Which of the following is the minimum number of counts for a Cesarean section case? - answer-4 Rationale: There is always a minimum of four (4) counts on a C-section: one prior to the incision, one prior to closure of the uterus, one prior to closing the abdominal cavity, and one prior to closing the skin. Seven would be too excessive and unnecessary. When transferring a patient to the operation room table, the surgical technologist should - answer-transfer medical equipment first and then move the patient. Rationale: Powering off medical equipment could harm the patient. Unlocked operating room tables increase the patients risk for injury. The safety strap should be snug for the safety of the patient without causing injury. Transferring medical equipment first ensures the equipment remains functional throughout the transfer. After scrubbing in and draping the patient, which of following does the surgical technologist need to check when preparing for a laparoscopic appendectomy procedure? (Select the three (3) correct answers.) - answer-Camera, Trocars, Light cords Rationale: The CO2 tank should be checked before the procedure is opened up or before the surgical technologist scrubs. The GIA stapler is used on open procedures. For a laparoscopic appendectomy, a camera and light cord are necessary to access the peritoneal cavity so the insufflation can be possible. Trocars are also necessary to for the laparoscopic instruments to enter the peritoneal cavity. Which of the following is a passive drain? - answer-Penrose Rationale: A Penrose is a passive drain that allows fluid to move out of the tube because the fluid is moving from an area of higher concentration (within the wound) to an area of lower concentration (the drainage sponge). The Hemovac, Jackson-Pratt, and Pleur-Evac drains are all active drains that use negative pressure to draw fluid out into a reservoir. Which of the following are duties the surgeon may delegate to the surgical technologist? (Select the three (3) correct answers.) - answer-Cut suture, Remove clamps, Retract tissue Rationale: Cutting suture, removing clamps, and retracting tissue can be done under the doctor's supervision. They are within the scope of practice a surgical technologist. However, surgical technologists cannot alter tissue, because they have not had the proper training and education. Which of the following actions by the surgical technologist reduces the risk of bioburden accumulation on serrated hemostatic forceps postoperatively? - answer-Soak in enzymatic solution within 20 minutes. Rationale: Instruments are not soaked in saline because it will pit them. Instruments should not be sterilized with rings together, because they cannot be properly sterilized. The instruments dry in sterile processing prior to being placed in the autoclave. Which of the following information is the surgical technologist responsible for reporting to the circulating R.N. to document in the OR record? - answer-Amount of x-ray contrast used Rationale: The circulator always documents all medication used during the procedure, including contrast. Propofol and Fentanyl are both used by anesthesia for general surgery. The amount of prep solution does not need to be documented.. The surgeon is using staples to close the skin on an abdominal incision after performing an exploratory laparotomy. Which of the following pickups should the surgical technologist use for this step? - answer-Adson Rationale: Adson's are used primarily for skin closure. Debakey's are for grasping fine tissue. Both Ferris Smith and Bonney forceps are for grasping heavy tissue or bone. Which of the following is the best method of terminal sterilization? - answer-Prevacuum steam sterilizer Rationale: Steam sterilization utilizes moist heat in the form of saturated steam under pressure within an enclosed environment and is the most dependable method of sterilization in which all microbes, including spores, are destroyed. When opening a sterile package at the back table, the package should be held - answer-way from the body. Rationale: When opening the back-table package on the back table the package should be checked for integrity. The outer wrapper should be removed and the package should be opened away from the surgical technologist. The break or seal should be removed, the first flap is opened away from the surgical technologist and then the second flap is open towards you. Your hands never should be over the sterile field because skin could flake off the arms and contaminate the back table set up. The package would never be opened upside down. The OR needs to be set up for a spinal laminectomy, where the surgeon has asked for a spinal positioner to arch the back in a prone position. Which of the following positioners should be chosen? - answer-Wilson frame Rationale: The Mayfield headrest is used to pin the head in neuro surgeries. A MorphBoard positioning device is a peg board used to position the hip in the lateral position. The Wilson frame is used to put the patient in the prone position to expose the back for a laminectomy. The Stulberg sliding bolster is used for knee surgery as a positioner. Which of the following key information should be on the outside of a peel package of a sterilized instrument? (Select the three (3) correct answers.) - answer-Sterile indicator, Name of item, Date of sterilization Rationale: The sterile indicator, name of item, and date of sterilization should all be labeled on the outside of the package. The date of use does not need to be on the package. It is not necessary to put the type of case the instrument is used in. The circulator has just poured sterile saline and sterile water onto the sterile field, but the surgical technologist did not verify. When asked, the circulator stated what the fluids were and that they were acceptable to use. Which of the following should the surgical technologist do at this point? - answer-Throw out the fluids and ask for replacements. Rationale: The circulator and the surgical technologist both most verify the fluids taken onto the sterile field. Any fluids should be marked on the appropriate containers before being administered. If the fluid was not verified it should be discarded and replaced with proper verification. Instruments and supplies have been opened by the surgical technologist for a case in Room 5. Soon after the surgical technologist was informed that the case has been moved to Room 1, but there is a similar case scheduled for Room 5 later that morning. Which of the following is the best course of action? - answer-Take unopened supplies to Room 1, build a new set-up, and break down Room 5. Rationale: If a room is delayed or cancelled, there is no way to ensure the set up remains sterile, unless a staff member stays in the room and monitors. Facility policy may also dictate a time frame for use of opened sterile items. The patient is to be draped for a laparoscopic cholecystectomy. After placement of towels, and prior to placement of the laparoscopic drape, the surgeon asks for a treated Ioban. For which of the following patient allergies would this drape be contraindicated? - answer-Shellfish Rationale: Ioban drapes are impregnated with iodine as an antimicrobial agent. Patients who are allergic to shellfish are of a higher likelihood to have sensitivity to iodine. For this reason, Ioban drapes should not be used on these patients The surgeon has finished dissecting through all of the layers of the abdomen during an abdominal hysterectomy. What retractor should the surgical technologist be prepared to pass to the surgeon? - answer-O'Sullivan O'Connor Rationale: After all the abdominal layers have been dissected, the surgeon will now be ready to begin working on removing the uterus. A self-retaining retractor, like the O'Sullivan O'Connor retractor, is most often used for this step of the procedure. A Burford-Finochietto is a self-retaining chest retractor. An Alexander Farabeuf is a rib raspatory. A Richardson- Eastman is a double ended hand-held retractor that would not be used for the duration of the hysterectomy. Which of the following items are needed for immediate use sterilization documentation? (Select the three (3) correct answers.) - answer-Patient ID number, Item sterilized, Sterilizing parameters Rationale: The required data needed to log a flash sterilization cycle are patient ID number, the item being sterilized and the parameters of the sterilization (temperature, length of cycle, and type of sterilization used). This information is essential for tracking purposes in case a patient develops an infection. Documentation of use of a flash sterilizer should also be made in the patient's chart. When opening a wrapped item using aseptic technique, the proper sequence is to open the top flap - answer-away from operator, side flaps opened, proximal flap opened last. Rationale: It is best to open the first flap away from while the remaining flaps are unfolded so the wrap is still covering the area closest to you. The side flaps will be opened next with the last flap opened away from you while not reaching over the sterile area. Which of the following chemicals used in the Perioperative Department is non-carcinogenic? - answer-Monsel's Rationale: Polymethylmethacrylate, formalin and ethylene oxide are all chemical hazards and are considered carcinogenic. Monsel's is a hemostatic agent and is non-carcinogenic. A patient's dentures are removed in the operating room. Which of the following is the proper procedure for the care of the dentures? - answer-The circulator places the dentures in a labeled denture cup and keeps them with the patient's chart. Rationale: Keeping the denture cup with the patient's chart, with a patient label on it, keeps it traveling with the patient, until the patient is awake, and ready to take possession of the dentures again. While preparing the room for a surgical procedure using the laser, which of the following policies ensure the laser is being used correctly? (Select the three (3) correct answers.) - answer-Post warning signs outside the room., Do not use alcohol based preps., Wear safety goggles. Rationale: Posting warning signs will prevent surgery doors from opening and causing unnecessary harm to co-workers outside the room. Not using alcohol based preps will decrease the risk of surgical fires. Safety goggles approved for that specific laser will prevent injury to the eye. Laparotomy sponges should be wet if available. The doctor should be in control of the foot control pedal to the laser. While preparing the room for a carotid endarterectomy, the surgeon walks in and tells the surgical technologist there is an emergent case scheduled next and the technologist needs to speed up the process of getting the patient prepped and draped. In order to have a safe outcome for the patient the technologist should prep the patient with - answer-Duraprep stick and place towels around the expected incision site. Rationale: A Duraprep stick typically requires the use of only one hand and is a faster method of prepping. The incision site does not need to be patted dry with Duraprep because it needs to be allowed to dry on the skin so the solution can properly reduce microorganisms during and after the procedure. Chlorhexidine is the same thing as Hibiclens and would not be used because it takes longer to prep with as opposed to the Duraprep stick. During a vascular procedure a vessel is ligated. The surgeon states that she will repair the vessel after bleeding is controlled. Which needle type would she most likely require to complete this task? - answer-Tapered needle Rationale: A tapered needle is often used for vascular, GI, and most soft tissue. A cutting needle penetrates through tougher tissue, such as skin. A control release needle is better for placing interrupted sutures or when there's a need for rapid release of the needle. Use of a French eye needle results in greater tissue damage than an eyeless needle, like the tapered needle. The surgical technologist has just completed scrubbing for a right knee arthroscopy. As the surgeon takes down the tourniquet, and the surgical technologist begins to breakdown the back table, a plume of smoke is seen coming from the sterile field. Which of the following is the most likely source of this smoke? - answer-The light source was left on and the drape is igniting. Rationale: The light source with the fiber-optic beam, along with a paper drape, would be where the smoke plume was coming from because of the heat. Iodine and lactated ringers are not a flammable liquids and would not be the source of the heat. A faulty ground pad would not be the source of the heat since it's not working properly. Postoperatively a hernia repair patient complains of ulnar pain, numbness and tingling bilaterally. The most likely cause of the patient's discomfort is that the surgical technologist forgot to - answer-place arm pads. Rationale: Adduction/abduction are motions performed during surgery. Axillary rolls are used during the lateral position. Arm pads are used throughout surgery to prevent damage to the ulnar nerve. The arms are placed on arm boards with the palm facing upwards. When breaking down the setup, which of the following steps should be completed first? - answer-All sharps are contained and disposed of in the sharps container. Rationale: At the end of every procedure the sharps need contained and put away first to prevent injuries. The other steps are done after the sharps are put away and disposed of in order to avoid getting stuck. After connecting the water seal drainage system to the chest tube, where should the technologist place the water seal drainage system? - answer-Below the level of the thoracic cavity Rationale: Placing the drainage system below the level of the thoracic cavity facilitates gravity drainage into the device. It cannot drain if placed higher than the level of the thoracic cavity. Placing the drainage tube higher may also result in fluid already collected to flow back into the chest cavity, which could cause an infection. After a tracheostomy procedure the surgical technologist should keep which of the following items sterile on the back table until the patient leaves the room? - answer-Tracheostomy hook and spreader Rationale: The hook and spreader should remain sterile on the back table—in case there are any complications and the tracheotomy tube needs replaced or fixed; they will aid in fixing or replacing the tube. The obturator helps position the tube. An endotracheal tube is used for general anesthesia. The surgical technologist is opening for a procedure and notices the wrapped item she just opened has a hole in the outer layer. Which of the following is the proper course of action? - answer-Discard the item and retrieve a new one. Rationale: If the integrity of the package has been compromised, it should not be taken on the sterile field. When in doubt, throw it out and get a new one. If the package has a hole it should never be used. If it were to be taken onto the sterile field it would contaminate the whole sterile field. An OB/GYN surgeon has posted an emergent laparoscopic case and the surgical technologist notices that his reusable metal trocar has not been processed from the day before. Which of the following sterilization methods is the best choice for this scenario? - answer-Flash sterilization Rationale: Ethylene oxide is a type of gas sterilization that takes several hours to complete. Steris is used for endoscopic equipment. Flash sterilization is the best option in this scenario since the trocar is required for immediate use. A cardiac arrest occurs during a thoracotomy procedure, and the surgeon calls a CODE BLUE. The surgeon is attempting to resuscitate the patient using CPR. Which of the following is the responsibility of the surgical technologist in this situation? - answer-Prepare internal defibrillator paddles. Rationale: The surgery is already in progress when the Code Blue is called the surgical technologist may be required to prepare the internal defibrillator paddles. The surgical technologist does not break scrub to get the crash cart the circulator will get any necessary equipment needed. While assisting the surgeon in draping a patient the surgical technologist is told that she has contaminated her gloves. Which of the following actions should the technologist take? - answer-Step away from the field and re-glove. Rationale: The drape is not contaminated, making removal of the drape unnecessary. There is also no need to cover the drape with a new one. Breaking scrub completely is not necessary because re-gloving is adequate if the scrub is able to do this without contaminating the gown. While preparing to open an instrument tray the surgical technologist notices that one of the indicators is not the proper color. Which of the following should the surgical technologist do? - answer-Discard the tray and retrieve a new sterilized instrument tray. Rationale: If the indicator strip did not turn, the tray should be considered contaminated and not used. The indicator must turn in order to show the proper sterilization. After the tray has been discarded, it is necessary to retrieve a new one. The tray should never be considered sterile. The patient is undergoing cardiothoracic surgery, and placed in the Sims position. Which of the following actions prevents the likelihood of an intraoperative positioning injury to the brachial plexus? - answer-Rationale: Placing a rolled towel, or gel pads under the down-side arm, will protect the brachial plexus during long surgical procedures. Extended time in the Sims position, can irritate this network of nerves, if not properly protected and padded while the patient is on the OR table. Before use of the ESU generator the surgical technologist should check for the - answer-biomedical engineering sticker. Rationale: These stickers are placed on the equipment, and updated with annual inspection information. If a piece of equipment does not have a sticker, or an in-range date, it should not be used. At the beginning of a carpal tunnel procedure the surgeon announces that he will use a Steven's scissor for every hand case he does from this day forward. After the case, which of the following is the most efficient way to make sure he has his Steven's scissor moving forward? - answer-Add the Steven's scissor to every hand procedure preference card for the surgeon. Rationale: Preference cards hold information for surgeon and case specific requirements. Putting the information on this card, will ensure that the scissor will be pulled, each time this surgeon does a hand case. Including the scissor in every hand tray is redundant, as all surgeons may not require its use. Notifying the Materials Management department of this request may be helpful, but will not be the best choice to ensure the surgeon has what he needs for future hand cases. A gynecologic oncology surgeon decides to bring her patient into the OR emergently after seeing her in the office. The patient's abdomen is greatly distended, warm and firm to the touch. Which of the following should the surgical technologist have available? - answer-Poole tip suction and Lap sponges Rationale: Poole suction can suction much more quickly than an Andrews tip, due to its size. Lap sponges have the ability to absorb greater quantities of fluid than a raytec does. A patient is undergoing a right partial pneumonectomy. Which of the following drains should the surgical technologist prepare for placement at the end of the case? - answer-Chest tube Rationale: Any time the chest cavity is entered and the normally present negative intrapleural pressure is compromised, a chest tube must be placed to reestablish the negative pressure. A Penrose is a passive drain that is partially placed within the wound allowing fluid to move out of the tube onto a dressing. The Jackson Pratt drain is commonly used for general and abdominal procedures for moderate drainage. The Hemovac drainage is commonly used for orthopedics for moderate drainage. After surgical drapes are removed, the circulating nurse recognizes what looks like a chemical burn on the patient's lower back. Which of the following prep solutions was most likely used to clean the patient? - answer-Iodophor Rationale: Chemical burns may be caused by antimicrobial prep solutions if it seeps and the solution is held tightly against the patient's skin. Chemical burns are most likely to occur when prep solutions come in contact with the rather delicate skin of the elderly or young children. The surgical technologist has started breaking down the back table and is disposing of all sharps. Which of the following is correct practice for disposing sharps? - answer-Place all sharps in the needle counter and dispose of them in the sharps container. Rationale: The surgical technologist should not recap hypodermic needles to prevent needle stick injuries. When unavoidable a one-handed technique is preferred. Sharps should be placed in a needle counter then disposed of in a sharps container. The surgical technologist is preparing for a myelography procedure. Which of the following items would definitely be on the preference card for this case? - answer-Contrast medium Rationale: A myelogram is a diagnostic imaging procedure used to visualize the spinal column and any diseases surrounding the spinal column. Contrast medium is essential in a myelogram in order to see detail in the spinal column not visible by CT scan or MRI alone. A periosteal elevator is used in open orthopedic procedures to scrape periosteum off bone. Prolene mesh is commonly used to repair hernias. A Williams retractor is a self-retaining retractor used in lumbar discectomy procedures. When is the water-seal drainage system placed during the thoracotomy procedure? - answer-Before initial pericostal incision is closed Rationale: A water-seal drainage system is a type of chest-tube used to help seal any air leaks in the pleural cavity and reestablish negative pressure. Therefore, it has to be placed before the pleura is closed towards the end of the procedure, not at the beginning. It stays in place at the end of the procedure. In a sterilized package, a chemical indicator is used to - answer-confirm that the package was exposed to sterilization. Rationale: The chemical indicator is used internally and externally to show that the package has been exposed to the sterilization process. They do not verify the sterility of the items in the packages. They only mean that the package has had the right temperature, humidity, and sterilant. It will not verify elimination of living flora on the package or that moisture is in the package. The surgical technologist is using the Sterrad machine. What does the Sterrad use for this sterilization method? - answer-hydrogen peroxide gas plasma Rationale: The Sterrad machine uses Hydrogen peroxide gas plasma while the Steris uses either peracetic acid or glutaraldehyde. Steam is used by a gravity-displacement steam sterilizer or a dynamic air removal steam sterilizer. When being relieved for lunch during surgery, which of the following tasks is performed by the outgoing surgical technologist? - answer-Counting sharps and sponges Rationale: The surgical technologist should ensure that all sharps and sponges are accounted for prior to being relieved for lunch or break. The surgical technologist must discard a malfunctioning sterilant and replace with a new one. Where should the surgical technologist look to find the proper disposal protocol for this product? - answer-Hospital MSDS log Rationale: MSDS sheets (Material Safety Data Sheets) contain information on all hazardous chemicals. They contain the precautions for handling the chemicals, the hazards associated with chemicals and the firefighting techniques—along with first aid for exposure. The hospital hazard log, manufacturer's packing, and materials management shipping log, would not contain the information needed. Which of the following are done during the initial count for a tubal ligation case? (Select the three (3) correct answers.) - answer-State the name of each item as you begin to count it, Circulator records the items counted, Count laps, Raytecs, needles, and blades Rationale: Dressings should not be opened until the end of the case. Counted items do include lap tapes, Raytecs, needles and blades, but not syringes. Always state each item being counted as you begin to count out loud with the circulator. The surgical team prepares the room for a trauma case. The nurse is notified by the ER that the patient is a 3-year-old female with a gunshot wound. In preparing the room for the patient's arrival, the surgical technologist should ensure that the room is - answer-maintained at 75 degrees F (23 C). Rationale: It is very difficult for pediatric patients to maintain a normal body temperature. Blood loss due to injury and shock for trauma patients makes it even more difficult. Protocol for pediatric cases in the OR is to keep the room temperature at 80-85 F for children under 25 lbs, and 75-80F for older children. When disinfecting a flexible endoscope used on a patient with TB, which of the following sterilization methods should be employed? - answer-Steris Rationale: The Steris is the machine used to clean and rid microorganisms from flexible endoscopes. Steam sterilization is not compatible with endoscopes because it will damage the endoscope. Bleach and enzymatic are both disinfectants. Which of the following factors determine if a disposable sterile supply item is acceptable to use? - answer-Package integrity and expiration date Rationale: The package should be checked for holes and the integrity should be good. The expiration date should be checked to make sure it has not expired. The expiration date is not on the case cart or preference card for the sterile supplies. A class II or a clean-contaminated surgical wound enters through where? - answer-Respiratory, GI, genital, or urinary tract Rationale: Class II: Clean Contaminated involves minor break in sterile technique. Controlled entry to aerodigestive (including biliary tract) or genitourinary tract; this includes respiratory and GI. The patient is scheduled to have a Meniscal repair done on his right knee. Which of the following best represents how the site should be marked in the preoperative holding area to verify correct surgical site? - answer-A "yes" written on the right knee, with a small line showing where the incision will be. Rationale: The operative site will be marked by the surgeon. Indelible marker should be used, so that prep solutions, drapes and tape do not inhibit the ability to read it clearly. The word "yes" or the surgeon's initials are commonly acceptable ways to mark the correct surgical site. "X" or "no" are not acceptable, as to it could lead to confusion or misunderstanding of whether site is correct or not. In preparation for a carotid endarterectomy the surgical technologist should anticipate using which of the following sutures? - answer-7-0 Prolene Rationale: The arteriotomy of a carotid endarterectomy is closed with Prolene. All vascular surgery utilizes non-absorbable suture such as Prolene While assisting the surgeon, the correct time for the surgical technologist to cauterize tissue is when the - answer-surgeon asks the surgical technologist to. Rationale: The surgical technologist's scope of practice does not include cauterizing tissue except when under a direct request from the surgeon. A charge nurse has just notified the surgical technologist to be prepared for a post-operative emergency for a post salpingo-oophorectomy. Which of the following is the instrumentation needed? (Select the two (2) correct answers.) - answer-Bookwalter retractor, Major set Rationale: The incision for this emergent procedure will most likely be a midline vertical incision, which would require a larger self-retaining retractor such as a Bookwalter. A Major instrument set will also be needed because it will have all the basic instruments for incision, dissection and hemostasis. A C-section set does have several basic instrumentations, but a Major instrument tray will have more instruments to use. A dilation and curettage set only has vaginal instruments in it. A Mayfield retractor is used during craniotomy procedures to hold the head in place. Which of the following is the correct means of sterilizing a non-flexible fiber optic endoscope? - answer-Steam Rationale: Steam sterilization would be the best way to sterilize a non-flexible fiber optic endoscope. (Also, the fiber optic endoscope would be cleaned and processed per manufactures recommendations.) Phenol is used as a disinfectant. Alcohol would not be used to clean or sterilize non-flexible fiber optic endoscopes. Peracetic acid is a high-level disinfectant and would harm the scope. The surgical technologist is assisting the surgical team in positioning the patient for a total hip arthroplasty. How can the surgical technologist plan for placing the patient in this position? - answer-Position the beanbag or pegboard on the surgical table. Rationale: The patient position for a total hip arthroplasty is usually lateral with the patient on a bean bag or peg board. A safety strap is routinely placed across the patient's thigh, but would be across the operative site in this case. The bean bag or peg board acts as the positioning safety device in this procedure. The patient remains in this position throughout the entire procedure. The Wilson frame is used for posterior spinal procedures. A surgical case ends, and the surgeon removes the drapes to finish dressings. What is the first action that the surgical technologist must take as the surgery ends and drapes are removed? - answer-Maintain back table and Mayo sterility. Rationale: The best practice is to keep the back table, mayo stand, and basin set sterile until the patient is out of the OR, being transported to the PACU. Several complications can occur, including respiratory distress, and the ST should be prepared to treat the emergency in the OR. Which member of the surgical team is in charge of the transfer of an immobile or unconscious patient from the OR table to the stretcher? - answer-Anesthesia provider Rationale: The anesthesia provider is in control of the patient transfer and coordinates the move. They have control of the head and the patient's airway. The surgeon most likely has already left the room and cannot help with the transfer. The circulator is on the other side of the bed waiting on the transfer device when anesthesia gives the permission. The surgical technologist is on the other side waiting to help transfer the patient. There should always be 4 people to transfer a patient. Anesthesia is at the head of the bed and one person is on each side with one at the end of the bed to help transfer the feet. If a Frazier suction tip falls on the floor during a procedure the proper protocol for flash autoclaving the item in a gravity displacement sterilizer is to - answer-flush the lumen and autoclave for 10 minutes at 270 degrees F. Rationale: Instruments with lumens must be autoclaved for 10 minutes. Prior to flash sterilizing a lumen, the inside of the lumen must be flushed. This allows residual water left in the lumen to become steam during the high temperature which will destroy the microbes present. 4 minutes would not be adequate time to achieve sterilization for an instrument with a lumen. A patient is having a hysteroscopy for myomectomy excision. The patient has been under anesthesia for an hour and is starting to show signs of extreme swelling. Which of the following is most critical to monitor in order to prevent these symptoms? - answer-Fluid intake and output Rationale: Excess fluid intake can cause fluid overload which causes edema. Monitoring fluid output is to make sure fluid is not only entering the body, but exiting it as well to reduce complications associated with edema. The volume and rate of flow of fluid must be carefully monitored. Glycine is used to irrigate body cavities. During a surgical procedure the surgical technologist notices a crack in the handle of the laparoscopic scissors. Which of the following should be the action of the surgical technologist? - answer-Inform the surgeon of the crack, ask the circulator for a replacement, pass off the damaged instrument for tagging. Rationale: The surgeon should be notified because the surgery is in progress. The circulator needs to be told so that they can go get a new one. The instrument should be handed off and tagged so it can be repaired. If it is placed back on the tray, the surgical technologist might forget it and send it to sterile processing and may end up in another surgery unrepaired. Which of the following retractors will the surgical technologist need for an emergent bring back case on a 450lb abdominal hysterectomy patient? - answer-Bookwalter Rationale: The Bookwalter is used for large abdominal wounds to provide adequate exposure and retraction. The Bookwalter is the optimal choice due to the size of the patient; the patient's size determines what retractors can be used. The O'Connor-O'Sullivan is used during open abdominal and pelvic procedures for exposure and retracting in smaller patients. A Nathanson is a liver retractor used to support and retract the liver during laparoscopic upper GI surgery. The Greenburg is a self-retaining retractor used for neuro surgery. Which of the following resources should the surgical technologist use if a question arises concerning the correct use of a cleaning solution? - answer-MSDS Rationale: OSHA is the Occupational Safety and Health Administration. CDC stands for the Centers for Disease Control and Prevention. Material Safety Data Sheets (MSDS) contains information on all hazardous chemicals: precautions for handling the chemicals, the hazards associated with chemicals, and the firefighting techniques--along with first aid for exposure. The Bowie-Dick test is used to test and monitor high vacuum steam sterilizer. The preferred liquid to use when wiping gross debris from instrumentation is - answer-water. Rationale: Water should be available and used to wipe down gross debris on instruments. Salt in the saline can cause pitting and corrosion on metal instruments, therefore it should not be used. Betadine and Hibiclens are antiseptic prep and scrub solutions. During surgery, the surgical technologist reaches for a supply item being handed by the circulator. The surgical technologist's left glove touches the outside of the package. Which of the following steps must be taken to correct the break in sterile technique? - answer-The circulator removes the contaminated glove and then the technologist re-gloves herself. Rationale: Because the surgery is already in progress, it is not necessary for the surgical technologist to re-scrub and re-gown. The circulator can remove the contaminated glove, and the surgical technologist can re-glove. The surgical technologist cannot remove their own glove, because the surgery is in progress. And the surgical technologist cannot leave the sterile field since the surgery is in progress. Which of the following substances used in the surgical environment is flammable? - answer-Isopropyl alcohol Rationale: Silver nitrate is a hemostatic agent. Acetic acid is also known as vinegar and is not flammable. Sorbitol solution is a sugar alcohol and is not flammable. Isopropyl alcohol is highly flammable and can start a fire. During the initial pre-operative count, the surgical technologist and circulator noticed that there were 11 Raytecs in a package instead of 10. Which of the following should they do about the extra sponge? - answer-Remove the package and the sponges from room. Rationale: If the patient has not entered the room the Raytecs are to be removed from the sterile field. They are then taken out of the room. Sponges used during the case are counted in the kick bucket so the incorrect sponges should not be placed in it. Raytec sponges come in a total of 10, so subtracting one from the count would complicate the surgery if relief would come in. After a surgical procedure, where should all unused surgical materials be returned to? - answer-Central Supply Rationale: Central Supply and the processing department is where the storage of sterile supplies are kept. All dirty instrumentation should be in a case cart and sent to the decontamination area there they are cleaned and washed. After they are cleaned they are taken to the instrumentation processing area. The surgeon has removed a specimen for a fresh section and is sending it to the lab immediately for a diagnosis. How should the technologist prepare the specimen for retrieval? - answer-Place the specimen in a dry specimen container. Rationale: A fresh specimen is one that has to be sent to the lab dry, and will then be fixed with a fixative solution upon arrival in the lab. Never remove any sutures the surgeon attached to the specimen which mark laterality. A tornado warning is in effect and power has been switched to the generator due to downed electrical lines. The hospital's disaster triage protocol has been activated. A surgical procedure is in progress. Which of the following is the best course of action to ensure patient safety? - answer-Finish the procedure and evacuate the patient. Rationale: Follow hospital's disaster plan for tornado preparedness and response. Under Joint Commissions standard codes, this would be categorized as a Code Brown, which is a weather related emergency. The best option in this instance is to complete the case, and then transfer the patient to a safe location for post-operative care. Which of the following is being tested when doing a Bowie-Dick test on an autoclave? - answer-Correct response: Amount of air removed from the autoclave Rationale: Bowie-Dick is the most commonly known DART test that should be performed on the autoclave. It ensures that the air is completely removed from the chamber and that it has been successfully replaced with steam. The surgical technologist is working on an emergent knee disarticulation. Which of the following scissors should the technologist expect to pass to cut the anterior cruciate ligament? - answer-Curved Mayo Rationale: The anterior cruciate ligament is a heavy fibrous tissue, so curved Mayo scissors should be used. Potts-Smith, tenotomy and Metzenbaum scissors are used on delicate tissue. During a vaginal hysterectomy the surgical team noticed that the safety belt was left off the patient before the drape was applied. How can the patient be secured to the OR bed without interrupting the sterile field or procedure? - answer-The circulator can reach under the sterile drape and apply the safety strap carefully. Rationale: The safety belt needs to be placed two inches proximal to the knees. A patient cannot be on an operating room table without a safety belt. This would endanger the patient's safety. The anesthesiologist is managing the patient's airway they cannot leave the patient to apply the safety belt. The surgeon is sterile and cannot apply the safety belt. The circulating nurse notices that the patient is actively bleeding from one of the operative sites and the surgeon has left the room. Which of the following actions should the surgical technologist take? - answer-Remain in gown and gloves and apply pressure. Rationale: The surgical technologist should remain sterile until the patient is out of the operating room and in PACU. If the surgical technologist has not broken scrub she can apply pressure until the surgeon is called back into the room. Since the field remains sterile it is not necessary to open a new sterile field. The surgical technologist is setting up for a bunionectomy. The surgeon's preference card is shown above. Which of the following is an essential item missing from this preference card? - answer-Power saw Rationale: The power saw is needed to remove the bunion from the foot. A wire is not used, so a wire cutter would not be necessary. There is not a break in a bone, so a cast would not be required. Ortho-Sorb is an absorbable pin, and a pin is not necessary. A GYN patient is scheduled to have a D&C procedure. To prevent the risk of skin and neurovascular pressure or injury when the patient is placed in stirrups in the lithotomy position, which of the following must the surgical team do? - answer-Have adequate padding available in room. Rationale: The patient's legs can be put in stirrups after anesthesia has given permission to move the patient's legs. The surgeon does not have to be in the room to position the patient. When positioning the legs in the stirrups it is necessary to pad the legs and feet. Which of the following tests is essential to ensure patient safety when processing a flexible endoscope? - answer-Leak Rationale: The leak test is essential: if a leak is found, it can damage the internal component. The scope could not be used on a patient because the integrity of the scope is broken. A visual inspection is done before the leak test. The white balance is done after the scope has gone through the sterilization process. Insufflation is done when the scope is being used on the patient. The patient is scheduled for insertion of a permanent pacemaker at 0800. In addition to key surgical team members, the absence of which of the following individuals would cause the case to be delayed? - answer-Manufacturer representative Rationale: The manufacturer representative should be present to calibrate the product for the surgeon's use and serve as a product expert to enhance patient safety. A unit coordinator, hospital transporter, or sterile processing personnel are not required to be present for surgical procedures. Which of the following is the minimum amount of time an unwrapped Kelly clamp needs to be flash sterilized for? - answer-3 minutes Rationale: The minimum amount of time is 3 minutes. Which of the following retractors has sharp disposable inserts that must be disposed of in an appropriate sharps container following the end of the surgical case? - answer-Mayfield Rationale: The Mayfield is a headrest that pins the head for stabilization. The pins used are very sharp and must be placed in the sharps container after the procedure. A Cloward is a hand held retractor used in an anterior cervical procedure. The Bookwalter is a self-retaining retractor used for open abdominal procedure. The Greenfield is a self-retaining retractor used on the brain. An alert, oriented, and mobile 300 lb. patient is brought into the OR on a transport cart. Which of the following is the best method of slowly transferring this patient to the OR bed? - answer-Align the beds together, lock the wheels, and ask the patient to move himself. Rationale: The mobile patient should be asked to move herself to the OR table independently. A minimum of two team members should be available to assist in any way possible. It is important to make sure all wheels are locked on both the gurney and the OR bed. When closing fascia after a laparotomy, which of the following is the suture of choice? - answer-PDS Rationale: PDS has a longer absorption rate of 183-238 days, which makes it ideal for the slow-healing fascia. Gore-Tex is typically used for anastomosis of vascular grafts or in valve repairs. Plain gut suture is not to be used on tissue under stress. Nurolon is a nonabsorbable suture that loses some of its tensile strength over time. Which of the following areas of the surgical gown is considered sterile? - answer-The front of gown from the mid-chest to the waist Rationale: The front of the gown from the mid-chest level to the waist and the sleeves circumferentially to 2 in proximal to the elbows is considered sterile. Following an eyelid laceration repair, the surgeon begins to close the skin. Anticipating the surgeon's needs, the surgical technologist should hand the surgeon - answer-steri strips. Rationale: Steri-trips are used to approximate would edges and hold them together. Staples would not be used on an eyelid laceration because they are metal. Dermabond would not be used because it is a liquid skin adhesive. Iodophor gauze is a packing that is used to pack wounds. Ten minutes into an automatic chemical washer cycle for an instrument string, the surgical technologist notices she has missed a few critical instruments. Which of the following should the technologist do? - answer-Wait until the cycle stops and run a new cycle with the instruments. Rationale: The correct protocol is to wait until the cycle stops, then add the instruments and start a new cycle. The instruments should not be added to the stringer until they have gone through the washer sterilizer. It is not good practice to abort the cycle. When steam sterilizing biological indicators, how long are they incubated before the reading is recorded? - answer-24 hours Rationale: Per CDC guidelines, steam sterilizer biological indicators must be incubated for 24 hours before the reading is recorded. The surgical team has just completed a radical mastectomy and the surgeon has left the room. While cleaning up the back table the surgical technologist notices the Jackson Pratt placed during this surgery is full with bright red fluid. Which of the following should the surgical technologist do next? - answer-Inform the circulator that the drain is full and there is the potential for active bleeding in the surgical site. Rationale: The circulator needs to be informed since there may be a potential active bleed and the surgeon has left the room. The surgical technologist should then remove the bulb and empty the contents in the appropriate container. The circulator should document the amount in the bulb. If the drain keeps filling up the surgeon would need to return to the room. The Jackson Pratt drain can be emptied since it has a removable bulb. A new one is not needed since it can be emptied and replaced. Since there is potential bleeding the surgical technologist should not cover it up. A surgical technologist is in the process of opening sterile supplies for an abdominal hysterectomy on a 300 lb. patient. After reviewing the preference card, which of the following items should the technologist hold in order to watch costs? (Select the three (3) correct answers.) - answer-Closing suture, 11 knife blade, Extra Raytec Rationale: A long Bovie tip would need to be opened because the patient is 300 pounds. Also extra lap tapes would be needed because of the patient weight and the potential for bleeding. Suture should be held because it may not be the correct suture needed because of the patient's size. An 11 blade is used on laparoscopic cases and would not be necessary for an open procedure. Raytecs should not be opened or free on opened procedures Which of the following hemostatic agents must be handled dry? - answer-Microfibrillar collagen/Avitene Rationale: Avitene must be handled dry because it will stick to wet surfaces. Prothrombin/ thrombin are enzymes that assist the blood in the clotting cascade. Bone wax is a waxy substance made from beeswax and can be handled with wet or dry hands. A surgical technologist working the night shift is preparing implants for the next morning. After running the autoclave, the cycle fails. Which of the following should the surgical technologist do? - answer-Unwrap, decontaminate and re-sterilize implants with a biological test pack and place a hold on the use of the sets until the BI test results are available. Rationale: Unwrap, decontaminate and re-sterilize implants with a biological test pack is the first step in the procedure. Then place a hold on the use of the sets until the BI test results are available. While cleaning the back table after a cystoscopy case, the tray of instruments accidentally falls on the floor. After retrieving all instruments, which of the following should the surgical technologist do before returning instruments to decontamination? - answer-Visually inspect the instruments. Rationale: The first thing that needs to be done is to visually inspect the instruments for cracks or breakage. The case is over, so the instruments do not need assembled. Central Sterile can be notified also, but that occurs after the surgical technologist inspects them. The contents would not be sent to Bio Med. Which of the following instruments can be decontaminated in a washer-sterilizer? - answer-Laser coated instrument set Rationale: The laser coated instrument set can be put in the washer-sterilizer. The power drill should not be submersed in liquid. The Phaco instrument set and the colonoscope should be hand washed since they are delicate and can be damaged. The surgeon is doing a laparoscopic procedure using an endo GIA stapler. He passes the stapler to the surgical technologist and asks him to reload. Which of the following should the technologist do to the stapler before passing back to the surgeon? - answer-Close the jaws. Rationale: The jaws must be closed to fit through the laparoscopic port. Each refill is single-use, therefore pre-firing the stapler will activate the staples, rendering the reload useless. There is no need to lubricate the jaws. The surgical technologist is opening for a procedure and notices the wrapped item she just opened has a hole in the outer layer. Which of the following is the proper course of action? - answer-Discard the item and retrieve a new one. Rationale: If the integrity of the package has been compromised, it should not be taken on the sterile field. When in doubt throw it out and get a new one. If the package has a hole it should never be used. If it was taken onto the sterile field it would contaminate the whole field. During a total abdominal hysterectomy, the surgeon is using a Balfour retractor. Which type of nerve injury is possible if this retractor is placed incorrectly inside the patient? - answer-Femoral Rationale: The most frequently used retractors in gyneco-obstetric surgery are O'Sullivan-O'Connor, Balfour, and Collins. Femoral nerve and abdominal-cutaneous nerve injury, along with splenic injury, are caused by the incorrect placement of such retractors. While preparing to do an abdominal hysterectomy on a 500 lb. female the surgical technologist begins to retrieve supplies and instrumentation. Which of the following retractor systems should the technologist retrieve for this case? - answer-Bookwalter Rationale: A Bookwalter is a large self-retaining retractor and is the best choice for abdominal retraction for this patient due to the adjustability of the ring size, and varied widths and lengths of retractor blades. A Chaux is a type of sternal retractor. The O'Connor O'Sullivan retractor is not the best choice for the patient due to the patient's larger size. A Greenberg retractor is commonly used in neuro or cranial procedures. During an otorhinolaryngologic procedure, which of the following precautions should the surgical technologist take if the anesthesia provider is using an uncuffed endotracheal tube? - answer-Moisten sponges and place around the field prior to start of procedure to minimize leakage and reduce heat buildup. Rationale: The uncuffed endotracheal tube should be filled with water, and wet sponges should be placed around it to minimize leakage. Saline should not be used, because it crystalizes. Methylene blue is dye and used to check the patency of the tubes. When opening sterile supplies aseptically for surgery the surgical technologist should - answer-open gown and gloves onto a small table away from where sterile items have been distributed. Rationale: The surgical technologist should open the gown and gloves onto the Mayo stand away from the sterile field. Extra supplies and implants should not be opened because it would increase the cost of the surgery. Suture and blades should always be visible to prevent injury and contamination. Sterility of the tray has not been confirmed so you would not open sterile supplies in the tray. During the liquid chemical sterilization, which of the following is the primary chemical sterilization compound used to sterilize endoscopic instrumentation and scopes? - answer-Peracetic acid Rationale: Peracetic acid is a used for sterilization. The three others answers are all used for environmental cleaning only. Which of the following instruments should be passed to the surgeon to achieve hemostasis at the beginning of an operative procedure? (Select the three (3) correct answers.) - answer-Electrosurgical pen, Sponge, Suction device Rationale: To achieve hemostasis, a sponge can be used to clear the area to see where the bleeding is coming from. An electrosurgical pen can be used to stop bleeding because the thermal heat will disperse to stop bleeding. The suction device is used to provide visualization so that the bleeding can be stopped. A scalpel is used to make an incision. Sponge forceps would not be used to control superficial bleeding at the beginning of the case. The scheduled case is a prostatectomy. The surgeon has requested chromic gut suture for reanastomosis. If Chromic gut is unavailable, which of the following sutures is a viable substitute? - answer-Vicryl Rationale: The acceptable substitute for a Chromic Gut suture would be a Vicryl suture. Vicryl, like Chromic Gut, it absorbable and would be the next best choice for reanastomosis in a prostatectomy. The surgeon has just completed a right ankle fusion and decided to apply a cast after closing the skin. Which of the following materials should the surgical technologist have available for the surgeon to apply before the cast? - answer-Webril Rationale: Webril is padding that is applied to an extremity before a cast is applied. Esmark is used to exsanguinate