22 Professional Practice Practice Questions & Answers

1. 1. Who is responsible for explaining the nature and risks of a procedure and obtaining the patient's written informed consent?

   • A.The surgeon performing the procedure, after confirming the patient understands✓ Answer
   • B.The circulator, who reviews the chart and completes the preoperative checklist
   • C.The certified surgical technologist who is assigned to scrub the case
   • D.The anesthesia provider, who meets the patient at the preoperative interview

   Obtaining informed consent is a physician duty: the surgeon must disclose the nature of the procedure, its risks, benefits and alternatives, and satisfy himself or herself that the patient understands. The circulator, the technologist and the anesthesia provider verify that a signed, dated and correct consent is present, but none of them may explain the procedure or obtain the signature on the surgeon's behalf.

   Source: AST Position Statement on Witness of Informed Consent; NBSTSA CST Exam Content OutlineReport a problem with this question

2. 2. When a surgical technologist signs as a witness on a consent form, that signature attests to which of the following?

   • A.That the surgeon's explanation of the operation was complete and accurate
   • B.That the identity of the signer was verified and the signing was voluntary✓ Answer
   • C.That the procedure and the surgical site listed have been confirmed as correct
   • D.That the patient understood the risks and the alternatives that were described

   A witness signature is a statement about the signature only: the person signing is who the form says, and the signature was given freely and without coercion. It is not an attestation that the patient comprehended the disclosure, because comprehension is the surgeon's responsibility to establish. Note also that the surgeon does not serve as one of the witnesses, and whether a technologist may witness at all is governed by facility policy and state law.

   Source: AST Position Statement on Witness of Informed ConsentReport a problem with this question

3. 3. In the preoperative area a patient scheduled for right knee arthroscopy tells the technologist she thought both knees were being done. The consent lists the right knee. What should be done FIRST?

   • A.Reassure the patient that the surgeon will decide about the left knee in surgery
   • B.Ask the patient to sign an addendum to the consent that covers the left knee
   • C.Explain to the patient that only the right knee appears on the signed consent
   • D.Report her statement to the circulator so the surgeon can speak with her✓ Answer

   A stated understanding that does not match the signed consent is a discrepancy that must be reconciled before sedation, and only the surgeon can re-explain the procedure and correct the document. The technologist escalates the concern through the circulator rather than explaining, reassuring or obtaining any additional signature, because all of those acts fall outside the technologist's scope.

   Source: Joint Commission Universal Protocol, pre-procedure verification; NBSTSA CST Exam Content OutlineReport a problem with this question

4. 4. Written consent for elective surgery on a nine-year-old child is properly given by which person?

   • A.The child, once a nurse has explained the operation in simple words
   • B.The surgeon, who documents that the operation is in the child's interest
   • C.Any adult relative who brings the child to the preoperative holding area
   • D.A parent or legal guardian with authority to consent for the child✓ Answer

   A minor is not legally competent to give surgical consent, so permission is given by a parent or by the legal guardian who holds decision-making authority; for an incapacitated adult the same role is filled by the authorized surrogate or health care agent. A relative without legal authority cannot consent, and a surgeon cannot substitute his own judgment of benefit for the required permission.

   Source: Joint Commission informed consent requirements; AST Standards of Practice, preoperative documentationReport a problem with this question

5. 5. A scrubbed surgical technologist needs an additional supply item during a procedure. Which action is correct?

   • A.State the request aloud to the circulator and keep working at the field✓ Answer
   • B.Wait for the surgeon to notice the missing item and ask the circulator for it
   • C.Step away from the field briefly and take the item from the supply cart
   • D.Reach past the back table to the cabinet and hand the wrapper to the circulator

   The non-sterile circulator exists precisely to obtain items for the sterile team, so the scrub communicates the need verbally and remains at the field. Leaving the field or reaching for stock breaks the technologist's assignment to the patient and the field, and waiting for the surgeon to discover the shortage delays the case and is not acceptable communication.

   Source: AST Standards of Practice; NBSTSA CST Exam Content Outline, roles of the sterile and non-sterile teamReport a problem with this question

6. 6. A relief technologist is taking over the scrub role during a case. What must occur before the original technologist removes gown and gloves?

   • A.Counts are completed and confirmed with the surgeon, circulator and both scrubs✓ Answer
   • B.The circulator documents the personnel change at the next scheduled count
   • C.The relief technologist reviews the surgeon's preference card for the procedure
   • D.The original technologist writes a note in the record describing the field setup

   Transfer of care during a case requires that the counts be done and agreed to be correct by the surgeon, the circulator, the departing technologist and the relief technologist while the departing technologist is still scrubbed and accountable for the field. Confirming afterward leaves no one who can answer for what was on the field at the moment of the exchange.

   Source: AST Standards of Practice for Transfer of Care During an Intraoperative CaseReport a problem with this question

7. 7. During a case the surgeon directs the scrubbed technologist to inject local anesthetic into the patient's incision line. How should the technologist respond?

   • A.Perform the injection once the circulator states the drug and strength aloud
   • B.Ask the circulator to reach in and inject while the technologist holds the tissue
   • C.Perform the injection, because a surgeon's direct order covers the technologist
   • D.Decline the injection, name the scope limit, and pass the syringe to the surgeon✓ Answer

   Administering a drug to the patient is an act reserved to licensed personnel, and a verbal order from a surgeon does not enlarge a technologist's legal scope of practice. The professional response is to state the limit calmly and keep the case moving by handing the prepared, labeled syringe to the surgeon, who administers the drug himself.

   Source: AST Guidelines for Best Practices in Surgical Technology, scope of practice; NBSTSA CST Exam Content OutlineReport a problem with this question

8. 8. While the wound is being closed, a technologist realizes that no one saw her write the wrong side on a specimen label. What should she do?

   • A.Tell the surgeon and circulator at once so the label can be corrected✓ Answer
   • B.Wait until the closing debriefing so the closure is not interrupted by it
   • C.Ask the circulator to relabel the container after the patient leaves the room
   • D.Quietly change the label at the back table and say nothing about the error

   A mislabeled specimen can send a pathology result to the wrong side and lead to a wrong operation, so the error must be disclosed while the surgeon is still present and can verify the correct site. The duty to report one's own error does not depend on whether anyone observed it, and a silent correction leaves no record that the identity of the specimen was ever re-verified.

   Source: AST Standards of Practice for Handling and Care of Surgical Specimens; AST Code of EthicsReport a problem with this question

9. 9. Which information belongs in the patient's intraoperative record with respect to the surgical counts?

   • A.The circulator's opinion about why an item was hard to find in the room
   • B.A copy of the occurrence report the team filed at the end of the case
   • C.The lot numbers printed on each sponge package opened for the case
   • D.The names and titles of the personnel who counted, and the result of each count✓ Answer

   The record must show what was counted, how many, who counted it with their titles, the result, any steps taken to resolve a discrepancy, and an explanation for any count not performed; the circulator records the counts and the technologist signs with credentials. An occurrence report is a separate risk-management document and is never copied into or referenced in the chart.

   Source: AST Recommended Standard of Practice for Counts (documentation)Report a problem with this question

10. 10. A technologist notices an entry she made minutes earlier in the intraoperative record is wrong. How is the correction made?

    • A.Cover the entry with correction fluid and write the accurate wording above it
    • B.Erase the entry completely and rewrite the line so the record remains legible
    • C.Ask the circulator to remove the sheet and replace it with a rewritten page
    • D.Draw one line through the entry, then initial and date the corrected version✓ Answer

    A health record is a legal document, so the original entry must remain readable and the fact that it was changed must be visible: a single line, the initials of the person correcting it, and the date. Erasing, whiting out or replacing a page destroys evidence and creates the appearance that the record was altered to conceal something.

    Source: Durable health-record charting rule; AST Standards of Practice, documentationReport a problem with this question

11. 11. What is the purpose of an occurrence (incident) report?

    • A.To identify the team member whose action was responsible for it
    • B.To record the objective facts of an event for the facility's risk management✓ Answer
    • C.To satisfy a rule that unusual events be described to the family
    • D.To give the patient's chart an explanation of the unexpected event

    An occurrence report is an internal risk-management and quality tool that captures only what was observed, in objective language, without opinion, blame or conclusions. It is not part of the medical record: it is not filed in the chart, and the chart must not state that a report was completed, since doing so would pull the document into the record.

    Source: Risk-management documentation principle; AST Standards of Practice, reportingReport a problem with this question

12. 12. Which four elements must be proved to establish negligence by a surgical technologist?

    • A.A duty owed, a written policy violation, an apology, and financial loss
    • B.An intent to harm, an unconsented touching, causation, and damages
    • C.A duty owed, a breach of that duty, causation, and resulting damages✓ Answer
    • D.An employment relationship, breach of contract, causation, and lost wages

    Negligence requires a duty of care owed to the patient, conduct that falls below the accepted standard of care, a causal link between that conduct and the harm, and actual damages; malpractice is simply negligence by a professional. Intent belongs to the intentional torts such as assault and battery, and contract elements belong to a different cause of action entirely.

    Source: Tort law elements of negligence; AST Guidelines for Best Practices, legal conceptsReport a problem with this question

13. 13. A sponge is seen on a postoperative x-ray after an abdominal case. Which legal doctrine does this fact pattern illustrate?

    • A.Informed consent, because the risk was disclosed before surgery
    • B.Respondeat superior, because the hospital employs the team members
    • C.Assault, because the patient was put in fear of a harmful contact
    • D.Res ipsa loquitur, because such an injury does not happen without negligence✓ Answer

    Res ipsa loquitur, 'the thing speaks for itself,' applies when the injury is of a kind that ordinarily does not occur without negligence, the instrumentality was under the control of the team, and the patient did nothing to contribute; a retained item is the classic example. Every member of the team shares responsibility, so the technologist is not shielded by the surgeon's authority.

    Source: AST Recommended Standard of Practice for Counts (shared liability, res ipsa loquitur)Report a problem with this question

14. 14. A hospital is held liable for the negligent act of a technologist it employs, committed during an assigned case. This liability rests on which doctrine?

    • A.Respondeat superior, which makes an employer answerable for employee acts✓ Answer
    • B.Corporate abandonment, which follows from leaving a patient unattended
    • C.Res ipsa loquitur, which infers negligence from the nature of the injury itself
    • D.Primum non nocere, which directs the practitioner above all to do no harm

    Respondeat superior, 'let the master answer,' makes an employer vicariously liable for the negligent acts of employees performed within the scope of their employment. It does not remove the individual's own liability: the technologist remains personally accountable for his or her conduct, and both may be named in the same action.

    Source: Vicarious liability doctrine; AST Guidelines for Best Practices, legal conceptsReport a problem with this question

15. 15. A surgeon removes an additional lesion that is not described anywhere on the signed consent form. Which tort does this best illustrate?

    • A.Assault, a threat that makes the patient fear an unwanted contact
    • B.Defamation, a false statement that harms the patient's reputation
    • C.Battery, an intentional touching to which the patient did not agree✓ Answer
    • D.Negligence, a failure to meet the accepted standard of care in surgery

    Battery is a harmful or offensive touching performed without valid consent, and surgery outside the scope of what the patient authorized is the textbook operating-room example, even when the operation is skillfully done and benefits the patient. Assault, by contrast, requires only apprehension of contact and no touching at all.

    Source: Intentional torts; Joint Commission informed consent requirementsReport a problem with this question

16. 16. A scrubbed technologist walks out of the room during a procedure without arranging relief. This conduct is best described as which of the following?

    • A.Invasion of privacy, because the patient's dignity was not protected
    • B.Battery, because the patient did not agree to a change of personnel
    • C.Abandonment, because the patient was left without the assigned care✓ Answer
    • D.Insubordination, because the surgeon's instructions were not followed

    Abandonment is severing a care relationship after it has been accepted and while the patient still needs it, without transferring that responsibility to a qualified person. A technologist who has scrubbed and accepted the field owes continuous accountability for it until relief is formally arranged and the counts and field are handed over.

    Source: Tort of abandonment; AST Standards of Practice for Transfer of CareReport a problem with this question

17. 17. A technologist photographs an unusual specimen with a personal phone to show a study group. Which statement applies?

    • A.The image is permitted provided it is deleted from the phone after class
    • B.The image may be shared with any staff who were not present in the room
    • C.The image is protected health information and requires documented consent✓ Answer
    • D.The image is acceptable because the patient's face does not appear in it

    A clinical image taken during care is protected health information because it is created in the course of treatment and can be linked back to the individual; the absence of a face does not de-identify it. Photography of the patient, the field or a specimen requires specific documented patient authorization and is done with facility-approved equipment, never a personal device.

    Source: HIPAA Privacy Rule, protected health information; NBSTSA CST Exam Content OutlineReport a problem with this question

18. 18. A patient's cousin stops the technologist in the corridor and asks how the operation went. What is the appropriate response?

    • A.Confirm only that the procedure is finished and the patient did well
    • B.Refer the cousin to the surgeon or the circulator, who can speak with the family✓ Answer
    • C.Describe the operation and let the cousin ask the surgeon about the details
    • D.Summarize the findings briefly, since the cousin came to the hospital today

    Protected health information may be disclosed only to those with a treatment need to know or to persons the patient has authorized, and a corridor is not a private setting in any case. Even confirming that the case is over discloses information, so the technologist directs the relative to the surgeon or circulator, who determine what may properly be shared.

    Source: HIPAA Privacy Rule, minimum necessary and permitted disclosuresReport a problem with this question

19. 19. A patient with a documented do-not-resuscitate order is scheduled for a palliative procedure. How is that order handled in the operating room?

    • A.It is honored without discussion, so no resuscitative measure may be started
    • B.It is void in the operating room, because surgery implies a wish to be treated
    • C.It is reviewed with the patient and team, then continued or suspended in writing✓ Answer
    • D.It is automatically suspended once anesthesia begins and restored afterward

    A do-not-resuscitate order is not automatically void in the operating room. It must be revisited before the procedure with the patient or the authorized surrogate, the surgeon and the anesthesia provider, and the decision to keep it, to modify it, or to suspend it for a defined period must be documented; an unaddressed order remains in force as written.

    Source: Patient Self-Determination Act; NBSTSA CST Exam Content OutlineReport a problem with this question

20. 20. Which document names another person to make health care decisions when the patient cannot?

    • A.An operative permit, listing the procedure and the site to be operated on
    • B.A general release form, waiving the facility's liability for complications
    • C.A durable power of attorney for health care, naming a chosen surrogate✓ Answer
    • D.A living will, describing the treatments the patient would want or refuse

    An advance directive is the umbrella term. A living will states which treatments the person does or does not want if unable to speak, whereas a durable power of attorney for health care appoints an agent who can make decisions the document itself did not anticipate. A surgical permit and a liability release are consent and contract documents, not advance directives.

    Source: Patient Self-Determination Act; advance directive definitionsReport a problem with this question

21. 21. A surgeon asks for a different retractor and suture than the ones listed, and wants that change kept for future cases. How should this be handled?

    • A.Change the card from memory a few days later, once the room is turned over
    • B.Update the preference card right after the case, with the surgeon's confirmation✓ Answer
    • C.Wait for the surgeon to send a written request to the department manager
    • D.Tell the next technologist verbally and leave the card as it is

    A preference card is a working document that is reviewed before the case and revised immediately after it, while the details are still accurate, and the revision is confirmed with the surgeon and entered through the facility's own process. An accurate card also contains cost: it prevents opening items that will not be used and prevents delays hunting for items that are.

    Source: NBSTSA CST Exam Content Outline; AST Guidelines for Best PracticesReport a problem with this question

22. 22. Maintaining certification through continuing education is best understood as which of the following?

    • A.A workplace benefit that applies while the technologist stays employed
    • B.A voluntary activity undertaken only when new equipment is purchased
    • C.A requirement imposed on a technologist after a disciplinary action
    • D.A professional obligation to keep one's knowledge and practice current✓ Answer

    Certification is a voluntary credential granted by a certifying board, but once held it carries a continuing duty to maintain competence, and the profession's code of ethics states that efficiency is maintained through continuing education. It is tied to the credential and the patient's right to current care, not to any employer, purchase or disciplinary event.

    Source: AST Code of Ethics, tenet on continuing educationReport a problem with this question

Practice questions based on the NBSTSA Certified Surgical Technologist exam content outline, AST standards of practice, and durable operating-room principles. CST is a mark of the National Board of Surgical Technology and Surgical Assisting; this site is not affiliated with or endorsed by NBSTSA or AST. Surgical counts, documentation, and what a technologist may perform are governed by your facility's policy and by state law, and sterilization parameters follow the manufacturer's written instructions — confirm all of these locally rather than from a practice test, and confirm current eligibility and exam requirements with the certifying board. About the CST exam →