22 Instrumentation & Sutures Practice Questions & Answers

1. 1. During a small-bowel resection the surgeon asks for an instrument to grasp and lift a loop of intestine without crushing it. Which ringed instrument, identified by fenestrated, flared jaws with a smooth toothless inner surface, is MOST appropriate?

   • A.Allis tissue forceps
   • B.Babcock forceps✓ Answer
   • C.Kocher (Ochsner) clamp
   • D.Rochester-Pean forceps

   The Babcock's fenestrated, flared jaw has a smooth, rounded inner surface, so it encircles a delicate tubular or looped structure (bowel, ureter, fallopian tube) and spreads holding pressure over a broad area instead of concentrating it. Allis forceps carry short interlocking teeth and the Kocher carries a heavy interlocking tooth at the tip, so both are traumatic and are reserved for tissue that will be removed or for tough structures such as fascia.

   Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify instruments by function, application, and classification; Nemitz, Surgical Instrumentation (grasping and holding instruments)Report a problem with this question

2. 2. While closing an open hernia repair, the surgeon needs to grasp and hold the tough edge of the anterior rectus fascia. Which heavy ratcheted clamp, distinguished by one-by-two interlocking teeth at the tip, should the CST pass?

   • A.Kocher (Ochsner) clamp✓ Answer
   • B.Crile hemostat
   • C.Babcock forceps
   • D.Adson tissue forceps without teeth

   The Kocher/Ochsner is a heavy crushing clamp whose one-by-two interlocking teeth bite into dense, fibrous tissue so it will not slip under traction, which is exactly what fascia requires. A Crile's transverse serrations are designed to occlude a bleeding vessel, and the atraumatic Babcock and toothless Adson cannot hold fascia securely enough for closure.

   Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify instruments by function, application, and classification; Nemitz, Surgical Instrumentation (clamping and occluding instruments)Report a problem with this question

3. 3. Before an arteriotomy, the surgeon asks for a clamp that will occlude the vessel without injuring the intima. Which jaw design identifies a non-crushing vascular clamp?

   • A.Crosshatched tungsten-carbide inserts set into the jaw
   • B.Multiple fine longitudinal rows of shallow atraumatic teeth along the jaw✓ Answer
   • C.One-by-two interlocking teeth at the tip of the jaw
   • D.A single row of heavy transverse serrations across the full jaw

   Non-crushing vascular clamps (DeBakey, Satinsky, Cooley pattern) have jaws with multiple fine longitudinal rows of shallow atraumatic teeth that grip the vessel wall with low, evenly distributed pressure, so flow is occluded without crushing the intima. Intimal crush injury promotes thrombosis and anastomotic failure, which is why heavy transverse serrations or interlocking teeth are never placed on a vessel that will be repaired.

   Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify instruments by function, application, and classification; Nemitz, Surgical Instrumentation (vascular clamps)Report a problem with this question

4. 4. The surgeon is dissecting a delicate plane between the gallbladder and the liver bed and then asks the assistant to cut a silk tie. In order, the CST should pass:

   • A.Metzenbaum scissors, then Mayo scissors✓ Answer
   • B.Metzenbaum scissors for both the dissection and the tie
   • C.Potts-Smith scissors, then Metzenbaum scissors
   • D.Mayo scissors, then Metzenbaum scissors

   Metzenbaum scissors have long shanks with short, fine, blunt blades built for dissecting delicate tissue planes, while Mayo scissors have heavy, broad blades intended for tough tissue and for cutting suture. Cutting suture with tissue scissors dulls and misaligns the fine blades, which is why suture scissors are kept separate on the Mayo stand; Potts-Smith scissors are angled vascular scissors used to open a vessel, not to dissect the gallbladder bed.

   Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify instruments by function, application, and classification; Nemitz, Surgical Instrumentation (cutting and dissecting instruments)Report a problem with this question

5. 5. Two ringed instruments are on the Mayo stand. One has narrow tapered jaws with transverse serrations running the length of the jaw. The other has short, broad jaws with fine crosshatched serrations and gold-colored finger rings. The second instrument is:

   • A.A needle holder; the gold rings mean it may be used only with wire suture
   • B.A hemostat; the gold rings mark it as a heavy-duty crushing clamp
   • C.A needle holder; the gold rings identify tungsten-carbide jaw inserts✓ Answer
   • D.A sponge forceps; the gold rings identify a single-use disposable instrument

   A needle holder is recognized by short, broad jaws with fine crosshatched serrations, a pattern that keeps the needle from rotating or shifting when it is driven through tissue; a hemostat's longer tapered jaws with transverse serrations are made to occlude a vessel. Gold-colored rings are the standard marking for tungsten-carbide inserts, which are harder than stainless steel, grip the needle better, and can be replaced when the surface wears smooth.

   Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify instruments by function, application, and classification; Nemitz, Surgical Instrumentation (suturing instruments and instrument anatomy)Report a problem with this question

6. 6. During an exploratory laparotomy for a ruptured appendix, a large volume of purulent fluid must be evacuated from the abdominal cavity. Which suction tip is MOST appropriate?

   • A.Baron suction tip
   • B.Frazier suction tip
   • C.Yankauer suction tip
   • D.Poole suction tip✓ Answer

   The Poole tip is a straight tube fitted with a perforated outer guard, so suction is distributed over many small openings and viscera or omentum cannot be pulled into a single port and injured — that design is what makes it the abdominal-cavity, high-volume tip. The Frazier and Baron tips are small-caliber right-angle tips for neurosurgery and ENT, and the Yankauer's tonsil tip is used in the oropharynx and for smaller, more localized fields.

   Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify instruments by function, application, and classification; Nemitz, Surgical Instrumentation (suctioning instruments)Report a problem with this question

7. 7. For a lower abdominal procedure the surgeon requests a self-retaining retractor that the CST assembles on the field from a frame with two lateral blades and a center (bladder) blade. This retractor is the:

   • A.Gelpi retractor
   • B.Weitlaner retractor
   • C.Finochietto retractor
   • D.Balfour retractor✓ Answer

   The Balfour is an abdominal self-retaining retractor whose two lateral blades hold the wound edges apart while an interchangeable center blade depresses and protects the bladder, and it must be assembled and its blades secured on the sterile field before use. Weitlaner and Gelpi retractors are small self-retainers for shallow incisions, and the Finochietto is a rib spreader used to open the chest.

   Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: assemble and maintain retractors; Nemitz, Surgical Instrumentation (retracting instruments)Report a problem with this question

8. 8. When passing a curved hemostat to the surgeon, the CST should:

   • A.Pass it tip first so the surgeon can inspect the jaws
   • B.Pass it with the ratchet closed on the first tooth
   • C.Lay it on the Mayo stand within the surgeon's reach
   • D.Place the finger rings firmly into the surgeon's palm with the ratchet unlocked and the tip curving in the direction of use✓ Answer

   An instrument is delivered ready to use: the handles are placed firmly into the surgeon's palm so the slap is felt, the ratchet is left unlocked so the jaws can be opened immediately, and the curve points in the direction the instrument will be used. Passing this way lets the surgeon keep both eyes on the operative field, which is the whole purpose of the technique; a locked ratchet or a tip-first pass forces the surgeon to look away and reposition the instrument.

   Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: pass instruments and supplies; Association of Surgical Technologists best practice for instrument passingReport a problem with this question

9. 9. To remove blood and tissue debris from instruments during a procedure, the CST should wipe them with a sponge moistened with:

   • A.Sterile water✓ Answer
   • B.Povidone-iodine solution
   • C.Hydrogen peroxide
   • D.Normal saline

   Instruments are wiped with sterile water because the chloride ions in saline attack the passive chromium-oxide layer on stainless steel and produce pitting and corrosion, which ruins box locks, serrations and cutting edges. Blood and debris are removed as they accumulate rather than allowed to dry, since dried bioburden is far harder to remove in decontamination and can interfere with instrument function during the case.

   Source: NBSTSA CST examination content outline, Ancillary Duties — Equipment Sterilization and Maintenance: decontaminate, clean and maintain instruments; instrument-care guidance in standard surgical technology textsReport a problem with this question

10. 10. At the end of a case, how should the CST prepare soiled instruments for transport to the decontamination area?

    • A.Submerge them in a basin of normal saline so blood cannot dry on the jaws
    • B.Let gross soil dry so it can be brushed off more easily in decontamination
    • C.Wrap them as they are and send them directly to the sterilizer
    • D.Keep them moist with water or an enzymatic pre-treatment product, open box locks, disassemble multi-part instruments, and transport in a closed, leak-proof, biohazard-labeled container✓ Answer

    Point-of-use treatment keeps blood and body fluids from drying into a hardened film that resists cleaning, and opening box locks and disassembling multi-part instruments exposes every surface — hinges, lumens and mating parts — to the cleaning agents that follow. Saline is never used because its chloride content corrodes stainless steel, and no instrument can be sterilized before it has been cleaned, because residual soil shields microorganisms from the sterilant.

    Source: NBSTSA CST examination content outline, Ancillary Duties — Equipment Sterilization and Maintenance: pre-clean using enzymatic cleaner and transport instruments to central supplyReport a problem with this question

11. 11. The external chemical indicator tape on a wrapped instrument tray has changed color. This tells the CST that:

    • A.The biological indicator placed inside the tray has passed
    • B.The package was exposed to the sterilization process, which by itself does not prove the contents are sterile✓ Answer
    • C.The load may be released without reviewing the sterilizer's physical printout
    • D.The contents are sterile and may be used without further checks

    An external chemical indicator is a process indicator: it reacts to one or more conditions of the cycle and only distinguishes a processed package from an unprocessed one. Proof that the lethal conditions were actually achieved comes from a biological indicator, whose highly resistant test spores are incubated to show whether they were killed, and release decisions also depend on the internal indicator and the sterilizer's physical monitoring record.

    Source: NBSTSA CST examination content outline, Ancillary Duties — Equipment Sterilization and Maintenance: interpret and understand chemical and biological indicatorsReport a problem with this question

12. 12. A power drill is being used on the femur during an open reduction. Which action by the CST is ESSENTIAL?

    • A.Pass the drill with the safety released so the surgeon can begin immediately
    • B.Irrigate the drill site continuously to dissipate heat and prevent thermal necrosis of bone✓ Answer
    • C.Raise the pneumatic pressure above the manufacturer's stated setting so the bit cuts faster
    • D.Immerse the handpiece in sterile solution between uses to cool it

    Friction between the bit and cortical bone generates heat rapidly, and bone cells die at temperatures well below boiling, so continuous irrigation carries the heat away and preserves the bone that must later heal around the implant. A power handpiece is never immersed because fluid entering the motor housing damages it and cannot be reliably removed, operating pressure must stay within the manufacturer's instructions for use, and powered instruments are always passed with the safety engaged.

    Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: assemble, test, operate and disassemble specialty equipment (power equipment); manufacturer instructions for useReport a problem with this question

13. 13. The surgeon is using 2-0 suture and asks for a finer strand. Which USP suture size is finer than 2-0?

    • A.1
    • B.5-0✓ Answer
    • C.2
    • D.0

    In the USP system, once sizes drop below 0 each additional zero means a smaller diameter, so 5-0 is finer than 2-0, while sizes numbered 1, 2, 3 and upward increase in diameter. Diameter matters clinically because a larger strand carries greater tensile strength but leaves more foreign material in the wound, so the smallest size that will hold the tissue is chosen.

    Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify appropriate usage of sutures and needles; United States Pharmacopeia suture size conventionReport a problem with this question

14. 14. For an end-to-end small bowel anastomosis, which needle point is MOST appropriate?

    • A.Taper point✓ Answer
    • B.Spatula (side-cutting)
    • C.Reverse cutting
    • D.Conventional cutting

    A taper needle has a round body that spreads tissue fibers apart rather than cutting them, so the hole it makes closes down around the strand — critical in bowel, where a cut track would leak intestinal contents. Cutting and reverse-cutting points are reserved for dense tissue such as skin, and spatula points are made for the layered tissue of the eye.

    Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify appropriate usage of sutures and needles; surgical needle point classification in standard surgical technology referencesReport a problem with this question

15. 15. A reverse cutting needle differs from a conventional cutting needle in that its third cutting edge is located on the:

    • A.Outer (convex) curvature of the needle✓ Answer
    • B.Body of the needle just behind the swage
    • C.Flattened top and bottom surfaces of the needle
    • D.Inner (concave) curvature of the needle

    Placing the third cutting edge on the outer convex curve leaves a flat surface facing the wound edge, so the needle is far less likely to cut back through the tissue toward the incision and tear out. That is why reverse cutting needles are favored for skin, tendon and other tough tissue where a suture must not pull through, while the conventional cutting needle carries its third edge on the inner concave curve.

    Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify appropriate usage of sutures and needles; surgical needle point classification in standard surgical technology referencesReport a problem with this question

16. 16. The surgeon must place sutures through friable liver parenchyma. Which needle point is designed for this tissue and also reduces the risk of glove puncture?

    • A.Reverse cutting
    • B.Spatula (side-cutting)
    • C.Blunt (taper-point blunt)✓ Answer
    • D.Conventional cutting

    A blunt point dissects friable parenchymal tissue apart instead of slicing it, so sutures in liver, kidney, spleen or cervix are less likely to cut through and cause further bleeding. Because the tip will not readily penetrate skin, blunt needles also lower the rate of sharps injury and glove puncture, which is why they are recommended where tissue permits.

    Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify appropriate usage of sutures and needles; surgical needle point classification in standard surgical technology referencesReport a problem with this question

17. 17. A wound is grossly contaminated after perforation of the colon. Which suture characteristic is preferred for closure of this wound, and why?

    • A.A monofilament strand, because the interstices of a braided suture can harbor bacteria✓ Answer
    • B.Braided silk, because of its superior handling and knot security
    • C.Braided synthetic suture, because it absorbs faster in infected tissue
    • D.A larger diameter strand, because more material adds strength

    Multifilament (braided) suture has capillarity: fluid and bacteria are drawn into the spaces between the filaments, where they are sheltered from phagocytes and antibiotics, so braided material is avoided in contaminated or infected wounds. A smooth monofilament offers no such interstices and provokes less tissue reaction, and the surgeon still selects the smallest diameter that will hold the tissue, since extra foreign material increases the inflammatory response.

    Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify appropriate usage of sutures and needles; Basic Science — Microbiology: surgical wound classification and infection controlReport a problem with this question

18. 18. During laparoscopy the CST must never lay the lighted end of a fiberoptic cable on the drapes because:

    • A.The intense light concentrated at the tip generates enough heat to ignite the drapes✓ Answer
    • B.Contact with fabric produces capacitive coupling and an electrosurgical burn
    • C.Contact with a drape immediately contaminates the sterile cable
    • D.The weight of the cable will fracture the optical fibers and dim the image

    A fiberoptic light source delivers a very high intensity beam, and at the free end that energy is concentrated in a few millimeters, producing enough radiant heat to scorch and ignite drapes and towels — a documented operating-room fire mechanism combining an ignition source with a fuel. The cable is therefore kept connected to the scope, and the light source is placed on standby whenever the cable is disconnected or not in use.

    Source: NBSTSA CST examination content outline, Ancillary Duties — Administrative and Personnel: recognize safety and environmental hazards including fire; Perioperative Care — Intraoperative Procedures: operate endoscopic equipmentReport a problem with this question

19. 19. For a side-to-side small bowel anastomosis, the surgeon asks for a device that will place two double staggered rows of staples and simultaneously divide the tissue between them. The CST should provide a:

    • A.Skin stapler
    • B.Linear (TA-type) stapler
    • C.Linear cutter (GIA-type) stapler✓ Answer
    • D.Circular (EEA-type) stapler

    The linear cutter fires two double staggered staple lines and drives a knife blade between them, so both sides of the transection are closed at the moment the tissue is divided and spillage of bowel contents is prevented. A linear TA-type stapler closes tissue but has no knife, the circular device is used for end-to-end anastomosis of a tubular structure, and the reload must always match the device and the tissue thickness per the manufacturer's instructions for use.

    Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: identify appropriate usage of stapling devices and assist with stapling devices; manufacturer instructions for useReport a problem with this question

20. 20. The only dispersive (patient return) electrode available is an adult pad, and the patient is a small child. The CST should:

    • A.Place the pad on the leg distal to the pneumatic tourniquet where there is room
    • B.Trim the pad with sterile scissors so it fits the child's thigh
    • C.Fold the excess pad over and secure the edge with tape
    • D.Obtain the correct pediatric-size electrode, because a dispersive electrode is never cut, folded or otherwise altered✓ Answer

    The dispersive electrode works by returning the current to the generator over a large surface area so that current density — and therefore heat — stays low at the skin; cutting or folding the pad reduces that area, concentrates the current and can burn the patient. Correct practice is to select the manufacturer-designated size for the patient, apply it over clean, dry, well-vascularized muscle as close to the site as practical, never tape it in place, and never position it distal to a tourniquet, where perfusion is absent.

    Source: Association of Surgical Technologists Standards of Practice for Use of Electrosurgery — patient return (dispersive) electrode selection and application; NBSTSA CST examination content outline, Ancillary Duties — Administrative and Personnel: apply basic principles of electricity and electrical safetyReport a problem with this question

21. 21. Which of the following is a MECHANICAL method of hemostasis?

    • A.Bone wax✓ Answer
    • B.Epinephrine added to a local anesthetic
    • C.Fibrin sealant
    • D.Topical thrombin

    Bone wax stops bleeding purely by physical tamponade: it is pressed into the cut surface of cancellous bone and plugs the open vascular channels, taking no part in the clotting cascade. Thrombin, fibrin sealant and epinephrine all act pharmacologically or chemically — thrombin converts fibrinogen to fibrin and is a topical agent only, because intravascular injection would cause widespread, fatal clotting.

    Source: NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: differentiate methods of hemostasis (mechanical, thermal, chemical); Basic Science — Surgical Pharmacology: hemostatic agentsReport a problem with this question

22. 22. At the closing count the CST and circulator find one more radiopaque sponge than the number recorded. This count is:

    • A.Incorrect; the surgeon is notified immediately and the facility's incorrect-count policy is followed✓ Answer
    • B.Correct, since no sponge is missing from the patient
    • C.Corrected by adding the extra sponge to the count sheet and proceeding to closure
    • D.Resolved by having the circulator note the discrepancy and continue

    A count is incorrect whenever the numbers do not reconcile, and that includes finding too many items — an extra sponge means the baseline number itself is in question, so an item could still be unaccounted for in the wound. The surgical technologist and circulator perform counts together, audibly and visually, and an unreconciled count requires immediate notification of the surgeon and completion of the institution's incorrect-count procedure, which is documented.

    Source: Association of Surgical Technologists Recommended Standard of Practice for Counts — incorrect count procedure; NBSTSA CST examination content outline, Perioperative Care — Intraoperative Procedures: perform counts with the circulator at appropriate intervalsReport 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 →