Surgical Tech — the credentialing body practice for the Surgical Tech credential

Time-out is performed:

1. After procedure
2. Before incision, with the whole team
3. Optional
4. During scrub

Answer: B — Before incision, with the whole team

A/C/D) Wrong. B) Correct — Joint Commission mandate.

Which task is OUTSIDE the CST's scope and belongs to the RN circulator?

1. Passing instruments
2. Setting up the back table
3. Verifying consent and administering IV antibiotics
4. Counting sponges with the circulator

Answer: C — Verifying consent and administering IV antibiotics

Consent verification and IV med administration are nursing functions. The CST participates in counts and sets up the field.

Drapes hung over the edge of the OR table are considered sterile:

1. Only on the top surface of the table
2. For the full length they hang
3. To within 1 inch of the floor
4. Only if disposable

Answer: A — Only on the top surface of the table

Once drapes fall below the level of the table top, they are considered non-sterile; only the top surface is sterile.

Glutaraldehyde and ortho-phthalaldehyde (OPA) are examples of:

1. Sterilants only when in vapor form
2. Low-level disinfectants
3. High-level disinfectants used for heat-sensitive semi-critical items like flexible endoscopes
4. Antibiotics

Answer: C — High-level disinfectants used for heat-sensitive semi-critical items like flexible endoscopes

These are high-level disinfectants used for heat-sensitive semi-critical items.

OR ventilation is maintained at:

1. Negative pressure relative to corridors
2. Positive pressure relative to surrounding areas with HEPA-filtered air and high air-exchange rates
3. Ambient pressure
4. No ventilation requirements

Answer: B — Positive pressure relative to surrounding areas with HEPA-filtered air and high air-exchange rates

ORs maintain positive pressure with HEPA filtration and high air changes per hour to limit airborne contaminants.

Standard steam autoclaving is NOT considered reliably effective against:

1. Prions (which require extended/elevated parameters or specialty disposal)
2. Bacterial spores
3. Common bacteria
4. Yeasts

Answer: A — Prions (which require extended/elevated parameters or specialty disposal)

Prions resist routine sterilization; protocols require extended high-temp cycles or disposable instruments. The notion that routine autoclaving destroys prions is a common misconception.

Which instrument set is a core requirement for a tonsillectomy?

1. Tonsil snare, tonsil forceps/grasper, and a mouth gag (e.g., Crowe-Davis or McIvor) for exposure
2. Laminectomy set
3. Bone dermatome
4. Phacoemulsification handpiece

Answer: A — Tonsil snare, tonsil forceps/grasper, and a mouth gag (e.g., Crowe-Davis or McIvor) for exposure

A) Correct — tonsillectomy requires a self-retaining mouth gag for exposure plus tonsil-specific grasping and snare instruments. B) A laminectomy set is used for spine surgery, unrelated to the oropharynx. C) A dermatome harvests skin grafts in plastics cases. D) A phaco handpiece is used for cataract removal, not tonsillectomy.

During cardiopulmonary bypass, cardioplegia solution is administered primarily to:

1. Sterilize the surgical field
2. Arrest the heart and protect the myocardium while the heart is stopped for surgery
3. Anesthetize the patient systemically
4. Prevent postoperative infection

Answer: B — Arrest the heart and protect the myocardium while the heart is stopped for surgery

A) Cardioplegia is not an antiseptic and does not sterilize anything. B) Correct — cold, potassium-rich cardioplegia stops the heart in diastole and protects myocardial cells during ischemic arrest on bypass. C) General anesthesia is provided separately by the anesthesia provider, not by cardioplegia. D) Infection prevention is achieved through asepsis and antibiotics, not cardioplegia.

The largest artery in the body is the:

1. Carotid
2. Femoral
3. Brachial
4. Aorta

Answer: D — Aorta

The aorta is the largest artery, originating at the left ventricle.

The Joint Commission's Universal Protocol requires:

1. Pre-procedure verification, site marking, and time-out
2. Only a time-out
3. Site marking only
4. Hand hygiene only

Answer: A — Pre-procedure verification, site marking, and time-out

Three components: verification, site marking, time-out — all required to prevent wrong-site/-patient/-procedure events.

The three elements required for a surgical fire (the 'fire triangle') in the OR are:

1. An oxidizer (e.g., supplemental oxygen), an ignition source (e.g., electrosurgical unit or laser), and a fuel source (e.g., prep solution, drapes, patient hair)
2. Electricity, water, and metal
3. Heat, humidity, and pressure
4. Anesthesia gas, blood, and suture

Answer: A — An oxidizer (e.g., supplemental oxygen), an ignition source (e.g., electrosurgical unit or laser), and a fuel source (e.g., prep solution, drapes, patient hair)

A) Correct — an oxidizer-enriched atmosphere, an ignition source, and a fuel source together create surgical fire risk; removing any one element prevents fire. B) Electricity/water/metal is not the recognized fire triangle model used in OR fire safety education. C) Heat, humidity, and pressure are unrelated environmental factors, not the fire triangle. D) Anesthesia gas, blood, and suture do not represent the standard oxidizer-ignition-fuel model.

After skin closure, a primary dressing is applied while:

1. The wound is still in the sterile field, before drapes are removed
2. The patient is in PACU
3. Drapes are removed first
4. On the stretcher only

Answer: A — The wound is still in the sterile field, before drapes are removed

Apply the sterile dressing before drapes come off so the wound remains protected by the sterile field.

What are the four surgical wound classifications?

Class I Clean — no break in technique, no entry into GI/GU/respiratory tract. Class II Clean-Contaminated — controlled entry into a tract (e.g., appendectomy). Class III Contaminated — major break in technique or fresh traumatic wound. Class IV Dirty/Infected — existing infection or perforated viscus.

Bovie (electrosurgical unit, ESU)?

Electrical current cuts + coagulates. Two modes: cutting (continuous waveform) + coagulation (intermittent). Monopolar (most common) requires patient return pad.

Smoke evacuation?

Surgical smoke contains carcinogens, viruses, viable cells. Always use smoke evacuator within 2 in of source. AORN recommendation.

Universal Protocol (Joint Commission)?

(1) Pre-procedure verification. (2) Site marking by surgeon. (3) Time-out before procedure. Prevents wrong-patient, wrong-site, wrong-procedure errors.

Why is an axillary roll used in the lateral decubitus position, and what does it protect?

An axillary roll placed just below (not directly under) the dependent axilla relieves pressure on the brachial plexus and axillary vessels from the weight of the thorax, helping prevent brachial plexus injury and vascular compromise during lateral positioning.

Major arteries to know?

Aorta (largest), carotid, subclavian, brachial, femoral, popliteal. Locations critical for prep + hemostasis.