ST Chapter 12: Surgical Case Management

Circumferential extremity

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

Package integrity being intact and not violated

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

Surgical Drapes

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

Move items only once if possible

During the process of setting up the sterile field, efficiency and economy of motion recommend that the surgical technologist: 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

Be scrubbed separately or last

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

Lithotomy

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

4

How many individuals are required to safely transfer a recently anesthetized patient from the OR table to the stretcher? A. None--wait until the patient can move him or herself B. 2 C. 3 D. 4

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

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

Nail Polish

In preparing a patient for surgery, which of the following should be removed to facilitate oxygen blood level assessment? A. Dentures B. Hearing aids C. Nail polish D. Makeup

Mechanisms of intraoperative heat loss

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

Reduce the microbial count on the skin to an irreducible minimum

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

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

The patient undergoing laparotomy should be prepped: A. In a side-to-side motion from bedside level to beside 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

Fowler's

The sitting position is a modification of which position? A. Trendelenburg B. Lithotomy C. Fowler's D. Kraske

Step on one leg of the Mayo stand

To secure the Mayo stand from moving during draping, what should be done? A. Push the Mayo 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

Supine

Trendelenburg, reverse Trendelenburg, Fowler's, and lithotomy are variations of which basic position? A. Decubitus B. Lateral C. Prone D. Supine

2 inches above the elbows

Up to what area of the arms does a surgical technologist scrub? A. 1 inch below elbow B. 2 inches below the elbows C. 1 inch above the elbows D. 2 inches above the elbows

The filters on the bottom of the container are intact and container is dry

What does the circulating nurse 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 container is dry D. The numbers of instruments on the tray are correct on the count sheet from CSPD

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

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

Wraparound

What is the name of the common disposable surgical gown style? A. Cylindrical B. Turnaround C. Wraparound D. Circumferential

Sphygmomanometer

What is the name of the device used to manually assess blood pressure? A. Electrocardiograph B. Glucometer C. Pulse oximeter D. Sphygmomanometer

Reduce possibility of retained foreign objects

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

Frog-legged

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

Flora

What is the term for the normal resident microbial populations found on human skin? A. Bioburden B. Flora C. Fomites D. Biologicals

Subungual

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

Called in

What is the term used when a surgical team member who is on standby must return to the facility to do a case? A. Called in B. Called up C. Pulled in D. Pulled up

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.

What should the surgical technologist do with his or her gown and gloves in preparation for donning after scrubbing? 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

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

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

Hyperextension/nerve damage

What would be the likely result of positioning the patient's arms on arm boards at a greater than 90 degree angle from the torso? A. Hyperextension/nerve damage B. Foot drop C. Hamstring strain D. Restriction of respiratory freedom

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

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 head first 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 head first in the position most comfortable for the patient

Gown tab or card

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

2 inches proximal to the knees

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

Double gloving

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

Closed gloving

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

CRNA

Which member of the surgical team gives permission for the patient to be positioned or transferred? A. CRNA B. Circulator C. CSFA D. CST

Open gloving

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

Dressings

Which of the following are NOT considered countable items for potential of retained foreign objects? A. Dressings B. Instruments C. Sharps D. Sponges

Height and weight

Which of the following are NOT included in operative vital sign measurements? A. Pulse B. Blood pressure C. Height and weight D. All of the above

Cylindrical

Which of the following describes the configuration of a Mayo stand cover? A. Flat B. Rigid C. Cylindrical D. Wraparound

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

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

Endo shears are used through laparoscopic trocar to separate tissue

Which of the following is NOT an example of blunt dissection of tissue? A. Ray-Tec is used over gloved finger against tissue B. Kitner is loaded on a Pean clamp during herniorrhaphy C. Surgeon and assistant pull open peritoneum bilaterally D. Endo shears are used through laparoscopic trocar to separate tissue

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

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 proved greater exposure of the operative area

Hair must be shaved from every incisional and ECG lead site

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 micro abrasions and increased microbial count

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

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

Remove paper bands around sponges; separate each sponge into separate piles while counting aloud with RN.

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 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 RN D. Remove paper bands around sponges, hold pack in hand and fan out to separate, and then count aloud while touching each sponge

Medical hand wash

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 stokes D. Medical hand wash

Sim's

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. Sim's

Prone

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

Reverse Trendelenburg with slight tilt to the left

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

They should be counted while all still on the back table

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

Padded footboard

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

Surgically clean

Which term describes the condition of a surgical technologist's skin following skin prep? A. Debrided B. Medically clean C. Surgically clean D. Sterile

Same side as person applying towels

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

Circulator and surgical technologist

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

Full coverage system

Which type of sterile gown uses battery-powered ventilation for the wearer? A. Reusable cloth B. Impervious backed C. Full coverage system D. Disposable fluid resistant

10 mL of sterile water

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