Chapter 12 Surgical Case Management

What are the 4 modes of transmission

1. indirect contact 2. droplet 3. direct contact 4. airborne

17. Up to what area of the arms does a surgical technologist scrub? a. 1 inch below the elbows b. 2 inches below the elbows c. 1 inch above the elbows d. 2 inches above the elbows

2 inches above the elbows

23. Where is the safety belt or strap placed on a patient in supine position on the OR table? a. 2 inches proximal to the ankles b. 2 inches distal to the knees c. 2 inches proximal to the knees d. 2 inches distal to the perineal region

2 inches proximal to the knees

Proective wraps (dust covers) can't be thicker than...

2-3 mm

26. The sitting position is a modification of which position? a. Trendelenburg b. lithotomy c. Fowler's d. Kraske

Fowler's

The ability to prevent penetration of fluid through material, resulting in contamination

IMPERVIOUS

Area designated for placement of sharps to prevent intraoperative injury to sterile team members

NEUTRAL ZONE

32. What should the surgical technologist do with his or her gown and gloves in preparation for donning after scrubbing? a. Open and toss gown and gloves into the basin set. b. Open and toss gown and gloves onto the back table. c. Open and toss gown and gloves onto unsterile Mayo stand. d. Open gown wrapper on unsterile Mayo stand, and open and toss gloves onto gown.

Open gown wrapper on unsterile Mayo stand, and open and toss gloves onto gown.

The passage of fluid through the lymphatic system or blood vessels to an organ or tissues

PERFUSION

4. Which component of personal protective equipment (PPE) has shown the ability to decrease disease transmission from needle punctures? a. double gloving b. full coverage system c. lead aprons/shields d. splash guard mask

double gloving

27. For which position would the head of the OR table be moved to the foot before the patient is placed on the table? a. Trendelenburg b. lithotomy c. lateral kidney d. jackknife

lithotomy

Linen packs can't weigh more than...

12 lbs

Linen pack can't be any larger than...

12" high x 12" wide x 20" length

Instrument sets can't weigh more than...

25 lbs

40. How many individuals are required to safely transfer a recently anesthetized patient from the OR table to the stretcher? a. None--wait until patient can move him- or herself. b. 2 c. 3 d. 4

4

Linen pack can't be denser than...

7.2 lbs/ft^3

Referring to the apex of the heart; used as a method of reading a pulse rate

APICAL

43. Which member of the surgical team gives permission for the patient to be positioned or transferred? a. Anesthesia provider b. Circulator c. CSFA d. CST

Anesthesia provider

41. Which of the following is NOT an example of blunt dissection of tissue? a. Gloved finger against tissue. b. Dissection sponge (peanut) c. Surgeon and assistant pull open peritoneum bilaterally. d. Endo Shears are used through laparoscopic trocar to separate tissue.

Endo Shears are used through laparoscopic trocar to separate tissue.

The purpose of the preoperative skin prep is to sterilize the patient's skin to prevent surgical site infections. a. True b. False

False

36. If a pack of sponges is found to have an incorrect number during the count process and the patient is on the OR table, what should be done? a. Discard the sponge pack into a trash hamper. b. Hand off the pack to the circulator who will remove it from the room. c. Ask the circulator to record the actual number on the count board for closing count verification. d. Hand off the pack to the circulator who will bag, label as incorrect, and isolate off field until case completion.

Hand off the pack to the circulator who will bag, label as incorrect, and isolate off field until case completion.

The position in which an individual is lying on his or her side; also called decubitus

LATERAL RECUMBENT

16. What is the appropriate method for delivering a sterile item to the back table from a peel package? a. Open peel pack away from self, using top flap to cover hand and arm, open item over center of back table. b. Open package laterally, and carefully slide item over glued edge onto top of back table. c. Open package toward self, then project item into air, aiming for back table. d. Open package laterally and completely, gently toss item without touching glued edge or going over back table.

Open package laterally and completely, gently toss item without touching glued edge or going over back table.

The area between the anus and scrotum in males or between the anus and vulva in females

PERINEUM

38. When transporting a patient on a stretcher through the OR suite corridors, which method should be followed? a. Pull the stretcher with the patient facing feet first and the patient flat and restrained. b. Pull the stretcher with the patient facing headfirst and the patient flat and restrained. c. Push the stretcher with the patient facing feet first in the position most comfortable for the patient. d. Push the stretcher with the patient facing headfirst in the position most comfortable for the patient.

Push the stretcher with the patient facing feet first in the position most comfortable for the patient.

6. What is the purpose of a radiofrequency tracking system in the operating room? a. Aid in chargeable items being input into system. b. Assist CSPD personnel in locating instrument trays. c. Prevent potential for patient misidentification. d. Reduce possibility of retained foreign objects.

Reduce possibility of retained foreign objects.

Rapid breaths that rise with body temperature

TACHYPNEA

The act or process of being twisted or rotated around an axis

TORSION

49. Which of the following statements regarding transfer of an awake, mobile patient from stretcher to OR table is INCORRECT? a. Both table and stretcher must be locked to prevent movement during transfer. b. One staff member is positioned on table side to receive patient and one on stretcher side to stabilize. c. Instruct patient to keep the blanket on during transfer, preventing hypothermia and for privacy. d. The safety strap is secured tightly across patient's waist to prevent possible fall due to narrow OR table.

The safety strap is secured tightly across patient's waist to prevent possible fall due to narrow OR table.

37. Which statement regarding instrument counts is CORRECT? a. They should be counted while all still on back table. b. They are unnecessary if only one tray is opened for use. c. They are required by state law for every surgical procedure. d. They have been replaced by routine practice of post-op x-ray to verify no retained instruments.

They should be counted while all still on back table.

8. During the surgical skin prep, areas that are considered contaminated should a. not be scrubbed at all b. need no special attention c. be scrubbed separately or last d. be scrubbed vigorously and first

be scrubbed separately or last

2. What is the term used when a surgical team member who is on standby must return to the facility to do a case?

called in

46. Which two members of the surgical team are responsible for performing the counts to prevent retained items? a. circulator and surgeon b. circulator and surgical technologist c. surgeon and first assistant d. surgeon and surgical technologist

circulator and surgical technologist

14. An assistant may be needed to properly perform which type of surgical skin prep? a. circumferential extremity b. midline vertical abdominal c. two-step prep with scrub and paint d. vaginal/perineal prep in lithotomy position

circumferential extremity

19. Which gloving method should be performed by the surgical technologist after donning a sterile gown and before setting up the back table? a. assisted gloving b. closed gloving c. open gloving d. triple gloving

closed gloving

5. Which of the following describes the configuration of a Mayo stand cover? a. flat b. rigid c. cylindrical d. wraparound

cylindrical

28. Which position requires anesthesia administration and intubation to be performed on the patient's stretcher prior to final positioning? a. lateral b. lithotomy c. prone d. supine

prone

51. What is the name of the device used to manually assess blood pressure? a. electrocardiograph b. glucometer c. pulse oximeter d. sphygmomanometer

sphygmomanometer

52. With what amount and which fluid is a 16 Fr., two-way Foley catheter with 5 cc balloon filled? a. 5 mL of sterile water b. 5 mL of sterile normal saline c. 10 mL of sterile water d. 10 mL of sterile normal saline

10 mL of sterile water

The act of listening to sounds within organs or areas of the body

AUSCULTATION

50. Which of the following is/are NOT included in operative vital sign measurements? a. Pulse b. Blood pressure c. Height and weight d. All of the above are considered operative vital sign measurements

All of the above are considered operative vital sign measurements

Spaulding Classification

Critical (exposed to sterile areas of the body; must be sterile); Semi-Critical (touches mucous membranes; recommended sterile or high level disinfected); Non Critical (touch the skin; can be cleaned or disinfected; less than high level disinfection)

Type of cream used as a hair removal method that does not cause microabrasions

DEPILATORY

33. What is the proper way to open a small, sterilely wrapped item for delivery to the sterile field? a. First flap is pulled and opened away from self and tucked into palm, side flaps are pulled and tucked into palm, and last flap is pulled toward self and secured before tossing item onto field. b. First flap is pulled and opened toward self, the side flaps are pulled open, and the last flap is pulled and opened away from self, then item is tossed onto field. c. Right flap is pulled and tucked into palm, left flap is pulled and tucked, top flap is pulled and opened toward self, and the bottom flap is opened away from self and secured before tossing onto field. d. Left flap is pulled and tucked into palm, right flap is pulled and tucked, top flap is pulled and opened away from self and tucked, and bottom flap is pulled toward self and secured before tossing item onto field.

First flap is pulled and opened away from self and tucked into palm, side flaps are pulled and tucked into palm, and last flap is pulled toward self and secured before tossing item onto field.

11. Which of the following statements regarding hair removal is INCORRECT? a. Hair must be shaved from every incisional and ECG lead site. b. Hair removal should be performed as close to the time of the procedure as possible. c. Hair removal is dependent upon surgeon's preference, patient factors, and surgical site. d. Hair removal using a razor can result in microabrasions and increased microbial count.

Hair must be shaved from every incisional and ECG lead site.

47. Which of the following descriptions of how to pour liquids into a container on the sterile field is correct? a. Hold the bottle 6 inches above and over the basin. b. Hold the bottle 6 inches above but with only the lip of the bottle over the basin. c. Hold the bottle 12 inches above and over the basin. d. Hold the bottle 12 inches above and with only the lip of the bottle over the basin.

Hold the bottle 12 inches above and with only the lip of the bottle over the basin.

30. Before opening any supplies for delivery to the sterile field, what must be verified? a. Removal of charge sticker b. Initials of person who prepared item c. Length of time item has been in storage d. Package integrity being intact and not violated

Package integrity being intact and not violated

20. Which of the following techniques of counting sponges on the sterile field is an example of best practice? a. Count packages, leaving paper bands around and intact to prevent mixing of sponges before use. b. Count quietly and to yourself, and record totals with a skin marker on the back table cover. c. Remove paper bands around sponges, separate each sponge into separate piles while counting aloud with the circulator d. Remove paper bands around sponges, hold pack in hand and fan out to separate, and then count aloud while touching each sponge.

Remove paper bands around sponges, separate each sponge into separate piles while counting aloud with the circulator

12. Which position is routinely used for flexible colonoscopy procedures and may be performed on the patient's stretcher? a. Fowler's b. Kraske c. lithotomy d. Sims'

Sims'

45. To secure the Mayo stand from moving during draping, what should be done? a. Push the Mayo stand against the wall. b. Step on one leg of the Mayo stand. c. Have the circulator hold the Mayo stand post. d. Grasp the back side of the tray with one hand.

Step on one leg of the Mayo stand.

29. Which of the following statements about lateral kidney positioning is INCORRECT? a. The lower leg is flexed, the upper leg is straight, and a pillow is between them. b. The lower leg is straight, and the upper leg is flexed, with a pillow under the lower leg. c. A small roll is placed under the nonoperative side axillary area to facilitate respiration. d. The patient's flank is positioned over the kidney lift to provide greater exposure of the operative area.

The lower leg is straight, and the upper leg is flexed, with a pillow under the lower leg.

48. What does the circulator verify before the surgical technologist places the basket of instruments on the back table? a. The internal indicator has changed color. b. The filter on the container lid has changed color. c. The filters on the bottom of the container are intact and the container is dry. d. The numbers of instruments in the tray are correct on the count sheet from CSPD.

The numbers of instruments in the tray are correct on the count sheet from CSPD.

Suction tubing and ESU cords are attached to the sterile drape with perforating towel clips to prevent contamination. a. True b. False

True

The ability to anticipate the needs of the surgeon is one of the most important skills for a surgical technologist to develop. a. True b. False

True

The legs of a patient being placed in the lithotomy position should be raised and lowered slowly and simultaneously by two unsterile personnel. a. True b. False

True

The proper sequence for performing intraoperative and closing counts is operative site, Mayo stand, back table, basins, kick bucket or off field. a. True b. False

True

3. Which type of sterile gown uses battery-powered ventilation for the wearer?

disposable fluid resistant

21. Which of the following are NOT considered countable items for potential of retained foreign objects? a. dressings b. instruments c. sharps d. sponges

dressings

31. What is the term for the normal resident microbial populations found on human skin? a. bioburden b. flora c. fomites d. biologicals

flora

25. What is the temporary position for a female patient for placement of urinary catheter prior to abdominal hysterectomy? a. frog-legged b. jackknife c. low lithotomy d. semi-Fowler's

frog-legged

10. The patient undergoing laparotomy should be prepped a. in a side-to-side motion from bedside level to bedside level b. in vertical strokes from superior prep margins to inferior prep margins c. from the periphery inward toward the incision site in a circular motion d. from the incision site outward toward the periphery in a circular motion

from the incision site outward toward the periphery in a circular motion

44. When turning the sterile gown, what is handed to the circulator that completes the gowning process? a. gloved hand b. glove wrapper c. gown tab or card d. gown wrapper

gown tab or card

24. What would be the likely result of positioning the patient's arms on armboards at a greater than 90° angle from the torso? a. hyperextension nerve damage b. foot drop c. hamstring strain d. restriction of respiratory freedom

hyperextension nerve damage

39. Radiation, convection, conduction, and evaporation are examples of a. instrument sterilization methods b. mechanisms of intraoperative heat loss c. methods of thermal hemostasis d. surgical suite ventilation controls

mechanisms of intraoperative heat loss

18. Which of the following would NOT be an appropriate method of performing a surgical scrub/skin preparation? a. anatomical timed b. brushless/waterless c. counted strokes d. medical hand wash

medical hand wash

7. During the process of setting up the sterile field, efficiency and economy of motion recommend that the surgical technologist (ST) a. move items only once if possible b. position back table close to door c. place as many instruments on Mayo stand as possible d. request that circulating RN open all supplies for case after ST is gowned and gloved

move items only once if possible

1. In preparing a patient for surgery, which of the following should be removed to facilitate oxygen blood level assessment?

nail polish

22. Which method of gloving is appropriate for placement of a urinary catheter as part of the skin prep? a. closed gloving b. open gloving c. double gloving d. unsterile gloving

open gloving

54. Which table attachment is required to safely maintain a patient in the reverse Trendelenburg position? a. anesthesia screen b. kidney braces c. padded footboard d. shoulder braces

padded footboard

9. The main purpose of the surgical skin prep is to a. provide a visible area of paint where the incision will be made b. reduce the microbial count on the skin to an irreducible minimum c. remove all resident and transient flora from the planned incision site d. sterilize the patient's skin to prevent post-op surgical site infections

reduce the microbial count on the skin to an irreducible minimum

55. Which position would facilitate exposure of the operative area during a laparoscopic cholecystectomy? a. Trendelenburg with slight tilt to the left b. Trendelenburg with slight tilt to the right c. reverse Trendelenburg with slight tilt to the left d. reverse Trendelenburg with slight tilt to the right

reverse Trendelenburg with slight tilt to the left

13. Which towel is placed first when squaring off the operative site? a. inferior margin b. superior margin c. same side as person applying towels d. opposite side from person applying towels

same side as person applying towels

34. What is the term used for the area beneath the fingernails that is cleaned with a pick during the surgical scrub? a. subacromial b. subdermal c. sublingual d. subungual

subungual

53. Trendelenburg, reverse Trendelenburg, Fowler's, and lithotomy are variations of which basic position? a. decubitus b. lateral c. prone d. supine

supine

42. Best practice states that all of the following items remain sterile until the patient leaves the room, EXCEPT the a. back table b. basin set c. Mayo stand d. surgical drapes

surgical drapes

15. Which term describes the condition of a surgical technologist's skin following skin prep? a. debrided b. medically clean c. surgically clean d. sterile

surgically clean

35. What is the name of the common disposable surgical gown style? a. cylindrical b. turnaround c. wraparound d. circumferential

wraparound