22 Patient Safety & Counts Practice Questions & Answers

1. 1. During the surgical pause immediately before the incision, what is ESSENTIAL for the scrubbed surgical technologist to do?

   • A.Keep counting instruments quietly so the case is not delayed
   • B.Stop all activity and actively take part in the verbal confirmation of patient identity, procedure, site and side, position, and the implants and equipment needed✓ Answer
   • C.Let the circulator confirm the information on behalf of the scrubbed team
   • D.Confirm the correct site with the surgeon after the incision is made

   The pause works only if every member of the team stops and independently agrees, because a single passive participant removes one of the redundant checks that catch a wrong patient, wrong site or wrong procedure before it becomes irreversible. Delegating the confirmation to one person recreates the single point of failure the pause exists to eliminate.

   Source: Joint Commission Universal Protocol — time-out performed immediately before the procedure with active participation of all team membersReport a problem with this question

2. 2. Who is responsible for marking the surgical site before the procedure?

   • A.The surgical technologist, at the time the skin prep is performed
   • B.The circulator, while the patient is transferred to the operating room table
   • C.The anesthesia provider, after induction of anesthesia
   • D.The licensed practitioner who will perform the procedure, involving the patient whenever possible✓ Answer

   The mark must be made by the person who is accountable for the operation and, whenever possible, while the patient is still awake and able to agree, so the mark carries the authority of the person who will actually operate and can be cross-checked against the patient's own understanding. A mark applied by anyone else breaks that chain of accountability and can propagate an error rather than catch it.

   Source: Joint Commission Universal Protocol — marking of the procedure site by the individual performing the procedureReport a problem with this question

3. 3. While opening supplies, the surgical technologist notices that the consent names one side of the body while the marked and prepped site is the other side; what should the technologist do FIRST?

   • A.Prep and drape both sides so the surgeon can choose
   • B.State the discrepancy aloud and stop the process so it is resolved before any incision is made✓ Answer
   • C.Assume the surgeon has newer information and continue setting up
   • D.Ask the circulator to correct the consent form so the paperwork matches the marked site

   Any unresolved mismatch among the consent, the mark and the plan must halt the process, because wrong-site surgery is prevented only in the window before the incision and every team member holds an independent obligation to stop the line. Altering the paperwork to fit the mark, or assuming someone else knows better, resolves the appearance of the conflict without verifying the underlying fact.

   Source: AST Guidelines for Best Practices — every team member's duty to report and resolve a verification discrepancy before incisionReport a problem with this question

4. 4. When placing a patient in the lithotomy position, which action BEST prevents nerve and circulatory injury?

   • A.Rest the back of the knee directly against the stirrup post for support
   • B.Position the legs after the skin prep so the perineum stays exposed
   • C.Raise and lower both legs slowly and at the same time, padding the point where the leg contacts the stirrup✓ Answer
   • D.Raise one leg into its stirrup and secure it, then raise the second leg

   Moving the legs together and slowly keeps the pelvis symmetrical and prevents the sudden shifts in venous return and the hip and lumbar torsion that one-leg-at-a-time movement produces, while padding protects the superficial nerve that crosses the outer aspect of the knee against the stirrup. Positioning must also be completed and checked before the prep begins, since the drapes make later inspection impossible.

   Source: AST Standards of Practice for Surgical Positioning — lithotomy position and padding of contact pointsReport a problem with this question

5. 5. Which describes the correct movement of the sponge during a routine abdominal skin prep?

   • A.Begin at the intended incision site and move outward in widening circles, discarding the sponge when the outer edge is reached✓ Answer
   • B.Begin at the periphery of the prep area and work inward toward the incision line
   • C.Prep a stoma or open wound first and then the surrounding intact skin
   • D.Return the sponge to the incision site after each circle so the center stays wet

   Prepping from the incision outward and never returning a used sponge toward the center keeps organisms moving away from the area that will be opened, since the sponge picks up flora as it travels over less clean skin. For the same reason the most heavily colonized areas, such as a stoma, open wound, groin or axilla, are prepped last with separate sponges.

   Source: AST Standards of Practice for Skin Preparation of the Surgical Patient — concentric outward technique and prepping contaminated areas lastReport a problem with this question

6. 6. If hair at the operative site must be removed, which method BEST reduces the risk of surgical site infection?

   • A.Shave the site with a razor in the operating room just before the prep
   • B.Shave the site with a razor the evening before surgery
   • C.Remove the hair with electric clippers, only if it interferes with the procedure, as close to the time of incision as possible✓ Answer
   • D.Apply a depilatory cream directly to the operative site without a patch test

   A razor creates microscopic breaks in the skin that let resident flora multiply in the interval before incision, so clipping is preferred and the interval between removal and incision is kept short. Hair that does not interfere with exposure or closure is best left alone, because the safest removal is no removal.

   Source: AST Standards of Practice for Skin Preparation — hair removal with clippers rather than a razor; CDC surgical site infection prevention recommendationsReport a problem with this question

7. 7. Sponge and sharps counts are performed at which points during a laparotomy?

   • A.Once before the incision and once after the patient has left the room
   • B.Only when the surgeon specifically asks for a count
   • C.Only at the beginning of the case and again once the skin is closed
   • D.Before the procedure begins, when closure of a body cavity begins, when closure of the fascia begins, and when skin closure begins✓ Answer

   The counts are tied to the closure of each layer that could hide an item, so that a discrepancy is discovered while the surgeon can still reach the space in question rather than after it is sutured shut. Additional counts are required whenever items are added to the field and whenever the scrub or circulating personnel change, and the circulator records the count while both people count audibly and see each item at the same moment.

   Source: AST Standards of Practice for Surgical Counts — sponge and sharps count intervalsReport a problem with this question

8. 8. The closing count is incorrect and one sponge cannot be located; what is the FIRST thing that must happen?

   • A.Complete the closure and obtain an x-ray in the recovery area
   • B.Repeat the count, and if the second count matches the first, document it and proceed
   • C.Record the count as correct once the waste containers have been searched
   • D.Inform the surgeon at once so the field and the room are searched and the wound can be explored before closure✓ Answer

   Only the surgeon can explore the wound, so notification comes first and drives the rest of the sequence: search the sterile field, the drapes, the floor, the linen and the waste, then wound exploration, and if the item is still missing an intraoperative radiograph is taken before the wound is closed and before the patient leaves the room. A repeated count that simply agrees with itself proves nothing about where the item went, and the entire event and its resolution must be documented.

   Source: AST Standards of Practice for Surgical Counts — procedure for an incorrect countReport a problem with this question

9. 9. Which practice BEST supports sponge accountability and prevents a retained item?

   • A.Use counted radiopaque sponges as the final dressing so nothing is wasted
   • B.Remove the string from a tonsil sponge so it does not trail into the field
   • C.Cut a laparotomy sponge down to fit a small cavity
   • D.Use only x-ray-detectable sponges inside the wound, never cut or alter them, and reserve non-radiopaque sponges for dressings✓ Answer

   An item can only be found on a film if it is radiopaque and can only be counted if it is intact, so cutting a sponge or removing its string destroys both the count and the ability to retrieve it. Radiopaque sponges are likewise kept out of dressings and postoperative packing so a later film is not misread as showing a retained sponge, and needles are handled the same way — passed one at a time through a neutral zone and kept in a puncture-resistant needle counter.

   Source: AST Standards of Practice for Surgical Counts — x-ray-detectable sponges, prohibition on altering counted sponges, and sharps accountabilityReport a problem with this question

10. 10. A medicine cup on the back table contains a clear solution with no label; what should the surgical technologist do?

    • A.Keep it until the end of the case and report it during the debriefing
    • B.Ask the circulator what was poured earlier and then use it
    • C.Label it from memory and continue with the case
    • D.Discard the solution immediately, because an unlabeled medication or solution can no longer be verified✓ Answer

    Every medication and solution on the sterile field is labeled the moment it is received — with the name, the strength, the amount, and the diluent when one is used — precisely because appearance cannot distinguish saline from a local anesthetic or one dilution from another; once that identity is lost, memory is not an acceptable substitute and the contents must be discarded. Labeling is required even when only one medication is in use, and the label must not obscure the graduation marks on a syringe.

    Source: AST Guidelines for Safe Medication Practices in the Perioperative Area; Joint Commission National Patient Safety Goal on labeling medications and solutions on and off the sterile fieldReport a problem with this question

11. 11. Which sequence correctly describes how a medication is received and handled on the sterile field?

    • A.The technologist selects the amount from the surgeon's preference card and draws it up without further verification
    • B.The circulator and the technologist confirm the name, strength and expiration together, the technologist labels it immediately on the field, and states the name and strength aloud each time it is passed✓ Answer
    • C.The circulator alone verifies the medication because the circulator opens the vial
    • D.Verification is needed only when more than one medication is present on the field

    Whenever the person who prepares a medication is not the person who administers it, two people must verify it independently, and the technologist's announcement at each pass is the last check before the drug reaches the patient. The technologist prepares, labels, tracks and reports the amount used but never selects the drug or determines the dose, which remains the responsibility of the surgeon administering it; empty vials and containers stay in the room until the end of the case as evidence of what was delivered.

    Source: AST Guidelines for Safe Medication Practices in the Perioperative Area — two-person verification, immediate labeling, and announcing the drug at each passReport a problem with this question

12. 12. Which action is correct when a tissue specimen is passed off the sterile field?

    • A.Leave the specimen on the back table until the end of the case so the field is not disturbed
    • B.Confirm the tissue and its site with the surgeon, keep the specimen from drying, and pass it off with verbal confirmation of the source and laterality✓ Answer
    • C.Label the container after the patient has left the operating room
    • D.Pass it off dry and uncovered so the laboratory can weigh it accurately

    A specimen is irreplaceable, so its identity must be fixed at the moment it leaves the patient: the surgeon states what it is and where it came from, the technologist repeats it aloud to the circulator, and the container is labeled with the patient, the source and the side. Allowing tissue to dry destroys cellular detail needed for diagnosis, and a delayed or silent hand-off is the point at which specimens are mislabeled or lost.

    Source: AST Standards of Practice for Handling and Care of Surgical Specimens — verification with the surgeon, prevention of drying, and labeling with source and lateralityReport a problem with this question

13. 13. Where should the dispersive (patient return) electrode be placed for a monopolar electrosurgical case?

    • A.On any hair-bearing surface, as long as the entire pad is in contact
    • B.Over a bony prominence, where the flat surface keeps the pad from wrinkling
    • C.Over scar tissue or an implanted metal prosthesis, which conduct well
    • D.Over clean, dry, well-vascularized muscle mass as close to the operative site as practical✓ Answer

    The pad must return the current over the largest possible area of well-perfused tissue, because blood flow carries away the heat generated at the interface; bone, scar, fat, hair and implants all concentrate current in a small area and produce a burn. Bipolar instruments need no dispersive electrode because the current passes only between the two tips, and the active electrode is kept in an insulated holster whenever it is not in use.

    Source: AST Standards of Practice for Use of Electrosurgery — placement of the patient return electrodeReport a problem with this question

14. 14. Before a laparoscopic case, why is it ESSENTIAL to inspect the insulation along the shaft of a monopolar active electrode?

    • A.Intact insulation makes a dispersive electrode unnecessary
    • B.A break in the insulation can divert current to tissue outside the surgeon's view, causing a burn that goes unrecognized✓ Answer
    • C.Intact insulation keeps the tip from sticking to coagulated tissue
    • D.Intact insulation reduces the amount of surgical smoke produced

    In minimally invasive surgery only a small portion of the instrument is visible on the monitor, so stray energy from a defect in the insulation, from direct contact with another metal instrument, or from capacitive coupling through an intact insulator into a surrounding conductor can injure bowel or vessels that the surgeon never sees. Such injuries often declare themselves days later as perforation, which is why the electrode, cord and insulation are inspected before use and any damaged item is passed off the field.

    Source: AST Standards of Practice for Use of Electrosurgery — insulation failure, direct coupling and capacitive coupling during minimally invasive surgeryReport a problem with this question

15. 15. A drape ignites near the airway during a head and neck procedure; what is the team's immediate priority?

    • A.Smother the flame with an additional dry drape and continue the procedure
    • B.Stop the procedure, remove the burning material from the patient and extinguish it with saline while the flow of oxygen is stopped✓ Answer
    • C.Activate the fire alarm and evacuate the room before touching the burning drape
    • D.Continue operating while the circulator locates a fire extinguisher

    A surgical fire needs an oxidizer, an ignition source and a fuel, so the response removes all three at once — the burning fuel comes off the patient, saline extinguishes it, and cutting the oxygen removes the enriched atmosphere that makes drapes and hair burn fiercely. Prevention follows the same triangle: allow alcohol-based preps to dry fully before draping, keep the active electrode and fiberoptic light cords holstered or off the drapes, and use the lowest oxygen concentration that maintains the patient's saturation.

    Source: AORN Guideline for a Safe Environment of Care — surgical fire triangle, prevention, and immediate responseReport a problem with this question

16. 16. Which statement about protective eyewear during a laser procedure is correct?

    • A.Ordinary prescription eyeglasses are sufficient because they cover the pupil
    • B.Only the person operating the laser needs eye protection
    • C.Eyewear must match the wavelength and optical density of the laser in use, and everyone in the room, including the patient, must be protected✓ Answer
    • D.Any tinted safety glasses provide adequate protection

    Laser eyewear works by filtering one specific band of light, so protection is meaningless unless the lens is rated for the wavelength of the laser being used and for the energy it must absorb. A reflected beam travels the same distance as a direct one, which is why the whole room is protected, the door is posted and covered, instruments in the field are non-reflective, and the patient's eyes are shielded.

    Source: AST Standards of Practice for Laser Safety — wavelength-specific protective eyewear for all personnel and the patientReport a problem with this question

17. 17. Which practice is correct when a pneumatic tourniquet is used on an extremity?

    • A.Position the cuff over the bony prominence at the elbow or knee for a firmer grip
    • B.Inflate the cuff before the limb is exsanguinated so that the tissues stay perfused
    • C.Apply the cuff over smooth, wrinkle-free padding at the widest part of the extremity and exsanguinate the limb with an elastic wrap before inflating✓ Answer
    • D.Apply the cuff directly to the skin so that it cannot slip during the procedure

    Padding distributes the cuff pressure and prevents skin pinching and shear, the widest part of the limb spreads pressure over the most soft tissue and away from superficial nerves that run over bony prominences, and exsanguinating first empties the venous system so a bloodless field is achieved at a lower pressure. Inflation time is tracked from the moment of inflation and reported to the surgeon at intervals, while the pressure setting and time limits follow the facility's policy and the manufacturer's instructions.

    Source: AST Standards of Practice for Use of the Pneumatic Tourniquet — cuff application, padding, exsanguination, and reporting of inflation timeReport a problem with this question

18. 18. Which measure BEST protects a patient with a known latex allergy?

    • A.Keep latex items on the sterile field but away from the patient's skin
    • B.Schedule the case as the first procedure of the day in a room prepared with latex-free supplies and a latex-free cart✓ Answer
    • C.Double-glove with latex gloves so no latex touches the patient
    • D.Wipe the room surfaces with alcohol immediately before the patient enters

    Latex protein becomes airborne and settles on room surfaces and in the ventilation system as the day's cases accumulate, so a room that has already run other cases exposes the patient even without direct contact. Scheduling first, removing every latex item rather than merely keeping it at a distance, and having a dedicated latex-free cart available addresses both contact and airborne exposure.

    Source: AST Guidelines for Best Practices — latex allergy precautions and a latex-safe environmentReport a problem with this question

19. 19. During intraoperative fluoroscopy, which approach BEST protects the scrubbed surgical technologist?

    • A.Hold the image receptor steady during each exposure
    • B.Limit the time of exposure, increase distance from the beam, and wear a lead apron and thyroid shield with a dosimeter✓ Answer
    • C.Rely on the lead apron alone and remain immediately beside the beam
    • D.Stand on the x-ray tube side of the C-arm for a better view of the field

    Scatter radiation falls off sharply with distance and accumulates with time, so time, distance and shielding together give far more protection than any one of them alone; the tube side of a C-arm produces the most scatter, and holding a receptor places the hands directly in the beam. A dosimeter shields no one but documents cumulative dose so exposure can be tracked over time.

    Source: AST Guidelines for Best Practices and AORN radiation safety recommendations — time, distance, shielding, and personal dosimetryReport a problem with this question

20. 20. What is the surgical technologist's role during induction of general anesthesia?

    • A.Move the patient's arms onto the armboards while the anesthesia provider secures the airway
    • B.Remain quiet and still, avoid opening noisy packages, and make no move to position or prep the patient until the anesthesia provider gives permission✓ Answer
    • C.Start the initial count on the field so that time is saved later in the case
    • D.Begin the skin prep as soon as the patient stops responding to voice

    Hearing is among the last senses lost and the first regained, and induction and emergence are the periods of greatest airway and cardiovascular instability, so noise and movement can both distress the patient and interfere with the anesthesia provider, who controls the head and airway and directs any movement of the patient. Positioning, prepping and any repositioning wait for that authorization, and the same quiet applies at emergence.

    Source: AST Standards of Practice for Surgical Positioning and Guidelines for Best Practices — team conduct during induction and emergenceReport a problem with this question

21. 21. Which finding MOST suggests the onset of malignant hyperthermia during a procedure?

    • A.Bradycardia with a steadily falling exhaled carbon dioxide level
    • B.A slow decline in urine output with otherwise stable vital signs
    • C.A rapid, unexplained rise in exhaled carbon dioxide, with tachycardia and muscle rigidity✓ Answer
    • D.A gradual fall in the patient's core temperature over the first hour

    Malignant hyperthermia is a runaway hypermetabolic reaction in skeletal muscle, so the earliest reliable signal is carbon dioxide being produced faster than it can be cleared; the temperature rise that names the condition is a late finding. The technologist's own role is recognition and support — keep the sterile field intact and covered, act as directed, anticipate a rapid closure, and help the circulator bring the crisis cart and cold irrigation into the room while the anesthesia provider treats the patient.

    Source: Malignant Hyperthermia Association of the United States recognition criteria; AST Guidelines for Best Practices — surgical emergenciesReport a problem with this question

22. 22. A scrubbed technologist sustains a needlestick from a suture needle during closure; what should be done FIRST?

    • A.Step away from the field, wash the site with soap and water, and report the exposure at once so evaluation can begin✓ Answer
    • B.Recap the needle, change the glove, and stay scrubbed until closure is complete
    • C.Finish the case and report the injury at the end of the shift
    • D.Squeeze the puncture to force out blood and apply a chemical disinfectant such as bleach

    Post-exposure evaluation and any indicated prophylaxis are most effective when started promptly, so the site is washed and the exposure reported immediately rather than at the end of the case, and the event is handled under the facility's exposure control plan. Squeezing the wound or applying caustic agents damages tissue without reducing transmission, and needles are never recapped by hand — sharps are passed one at a time through a neutral zone and kept in a puncture-resistant container on the field.

    Source: OSHA Bloodborne Pathogens Standard — exposure incident washing, immediate reporting and post-exposure evaluation; AST Guidelines for Best Practices — neutral zone sharps handlingReport 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 →