22 Patient Safety & Counts Practice Questions & Answers

1. 1. During the time out before incision, the consent reads "left inguinal hernia" but the skin mark is on the right groin. What does the team do?

   • A.The surgeon states the correct side aloud and the incision proceeds at the marked site.
   • B.The team stops all activity and does not incise until the discrepancy is resolved.✓ Answer
   • C.The circulator corrects the consent in the chart and the team continues with the mark.
   • D.The time out is repeated after draping so the side can be settled during exposure.

   The time out exists precisely to catch mismatches among the consent, the schedule, the mark and the patient; any element that does not agree means the procedure is halted and every team member, the scrubbed technologist included, participates in resolving it before the skin is opened. Proceeding on one person's verbal assurance, or altering the record to match the mark, removes the only barrier standing between the patient and a wrong-site operation.

   Source: Universal Protocol (Joint Commission) — time out: any unresolved discrepancy stops the procedureReport a problem with this question

2. 2. Who marks the surgical site, and under what condition is the marking done?

   • A.The anesthesia provider marks it during the preoperative interview before sedation.
   • B.The licensed practitioner performing the procedure marks it, with the patient involved.✓ Answer
   • C.The surgical technologist marks it with a sterile pen after the prep is finished.
   • D.The circulating nurse marks it while the patient is being positioned on the table.

   Site marking is a verification step, not a clerical one, so it belongs to the practitioner who will actually perform the operation and is done while the patient is still awake and able to confirm the side or level. Marking by someone who was not going to operate, or after the patient is anesthetized, prepped or draped, breaks the chain of independent confirmation the mark is supposed to provide.

   Source: Universal Protocol (Joint Commission) — site marking by the individual performing the procedure, with patient involvementReport a problem with this question

3. 3. At which points during an open abdominal procedure are sponge and sharp counts performed?

   • A.When peritoneal closure begins, when fascial closure begins, at skin closure, and again in the recovery unit.
   • B.Before the skin incision, when peritoneal closure begins, and once more as the dressing is being applied.
   • C.Before the skin incision, when peritoneal closure begins, when fascial closure begins, and at skin closure.✓ Answer
   • D.Before the skin incision, at the midpoint of the procedure, when fascial closure begins, and at skin closure.

   Sponges and sharps are counted at four ordered events: an initial baseline before the skin is opened, then at the start of closure of the first cavity layer, again at the start of fascial closure, and finally as skin closure begins. The intervals are placed so that a missing item is discovered while the layer that could still hide it is open, which is why a count taken only at dressing time or after the patient has left the room is useless.

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

4. 4. An instrument count is performed at which points in a procedure that enters a body cavity?

   • A.Before the skin incision and again before closure of the body cavity begins.✓ Answer
   • B.Before the skin incision and at every sponge and sharp count interval after it.
   • C.Only before closure of the cavity, because the setup count covers the opening.
   • D.Before the skin incision, at fascial closure, and once more at skin closure.

   Instruments are counted at two events only, before the skin incision and before closure of the body cavity, because an instrument is too large to be retained in the fascial or subcutaneous layers that the later sponge counts protect. Assuming that instruments follow the same four-point schedule as sponges is one of the most common errors on this topic, and dropping the baseline count is just as wrong, since without it the closing number means nothing.

   Source: AST Standards of Practice for Counts — instrument count intervalsReport a problem with this question

5. 5. The closing sponge count is off by one. What must be done FIRST?

   • A.The count is repeated in silence before anyone else is told.
   • B.The wound is closed while the team searches the trash and linen.
   • C.The surgeon is informed at once that the count is incorrect.✓ Answer
   • D.A radiograph is ordered so the film is ready when closure ends.

   The first action in an incorrect count is always to tell the surgeon, because only the surgeon can stop closure and explore the wound while the item is still retrievable. Repeating the count quietly, closing during the search, or jumping straight to a radiograph all let the wound close over an item that could still be recovered by the simplest means.

   Source: AST Standards of Practice for Counts — incorrect count resolution sequence (notify the surgeon first)Report a problem with this question

6. 6. The surgeon has explored the wound and the team has searched the field, floor and linen, but a suture needle is still missing. What happens next?

   • A.An intraoperative radiograph is taken before closure and read by a radiologist.✓ Answer
   • B.Se toma una radiografía en recuperación cuando el paciente ya esté estable.
   • C.The count is charted as incorrect and the wound is closed with the surgeon's approval.
   • D.The needle is presumed to be in the discarded trash and skin closure proceeds.

   When a search and wound exploration fail, the radiograph must be obtained before the wound is closed and before the patient leaves the room, and it must be interpreted by a radiologist rather than by the surgical team. Deferring the film to the recovery area, or simply charting the count as incorrect and closing, converts a recoverable error into a retained surgical item that will require a second operation.

   Source: AST Standards of Practice for Counts — radiographic verification before wound closure, interpreted by a radiologistReport a problem with this question

7. 7. Which of the following is an accountable item that must be included in the sharps and miscellaneous count?

   • A.La gasa de apósito abierta al campo cuando ya se cierra la piel.
   • B.The empty suture packets kept as a record of the needles that were used.
   • C.The prep applicators used on the skin before the drapes are applied.
   • D.The electrosurgical tip cleaning pad used to scrape eschar off the active tip.✓ Answer

   An item is accountable when it is small enough to be lost in a wound and is present on the field during the procedure, which is exactly the case for the abrasive tip-cleaning pad, so it is counted like any other miscellaneous item. Dressing sponges are deliberately non-radiopaque and are kept off the field until skin closure is finished, prep applicators never enter the wound, and empty suture packets are only wrappers and can never be used to account for a missing needle.

   Source: AST Standards of Practice for Counts — countable sharps and miscellaneous itemsReport a problem with this question

8. 8. A patient with a ruptured abdominal aortic aneurysm is opened immediately and no initial count can be taken. How are counts handled?

   • A.An initial count is reconstructed from the opened wrappers at the end of the case.
   • B.Counts are omitted for the whole case and the reason is noted at the debrief.
   • C.The count is deferred to the receiving unit once the patient has been stabilized.
   • D.A closing count is performed and a radiograph is obtained before the patient leaves.✓ Answer

   A life-threatening emergency can legitimately make the baseline count impossible, but it never cancels accountability: the team still counts at closure and obtains a radiograph before the patient leaves the operating room, and the omitted initial count with its reason is documented. Rebuilding a baseline from wrappers is unreliable because items added in the rush may never have been recorded, and no count can be handed off to a unit that did not open the supplies.

   Source: AST Standards of Practice for Counts — emergency procedures: closing count plus radiographic verificationReport a problem with this question

9. 9. How are surgical counts carried out at the field?

   • A.The technologist and circulator count aloud together, both viewing each item.✓ Answer
   • B.The technologist counts aloud while the circulator records from the sheet.
   • C.The technologist counts silently and reports the totals to the circulator afterward.
   • D.The circulator counts the field items and the technologist the back table.

   Counts are concurrent and audible: the technologist and the circulator count at the same time, in the same facility-defined sequence, with both individuals actually seeing and separating each item as it is named. A count spoken by one person while the other only writes, or split so that each counts a different area alone, loses the independent double verification that makes the number trustworthy.

   Source: AST Standards of Practice for Counts — counts performed concurrently and audibly by the CST and the circulatorReport a problem with this question

10. 10. A patient is placed in lithotomy with the calves resting against the stirrup posts. Which injury does this position most directly threaten?

    • A.Femoral nerve traction at the inguinal ligament, causing loss of the ankle jerk.
    • B.Ulnar nerve compression at the elbow, causing numbness of the small finger.
    • C.Common peroneal nerve compression at the fibular head, causing foot drop and inversion.✓ Answer
    • D.Radial nerve compression in the upper arm, causing wrist drop on that side.

    The common peroneal nerve runs superficially around the head of the fibula with almost no soft tissue over it, so the lateral calf pressing against a stirrup post compresses it and produces foot drop; padding the stirrups and keeping the lateral calf off the bar is what prevents it. The same position also requires that both legs be raised and lowered slowly and simultaneously by two people and that hip flexion stay within physiologic limits, since the vascular and compartment risks rise with the length of the case.

    Source: AST Standards of Practice for Surgical Positioning — lithotomy and common peroneal nerve protectionReport a problem with this question

11. 11. A supine patient's arm is secured on an armboard. Which arrangement is correct?

    • A.The arm is abducted less than 90 degrees, palm up, with fingers extended.✓ Answer
    • B.The arm is abducted beyond 120 degrees, palm down, with fingers flexed.
    • C.The arm is tucked with the palm down and the elbow pressed on the rail.
    • D.The arm is raised above the head, palm up, and strapped to a padded board.

    Abduction beyond 90 degrees stretches the brachial plexus over the head of the humerus, and pronating the forearm rolls the ulnar nerve against the hard surface at the elbow, so the arm is kept under 90 degrees with the palm turned up. Pressing the elbow against a metal rail adds both a nerve compression point and an alternate path for electrosurgical current.

    Source: AST Standards of Practice for Surgical Positioning — supine position, arm abduction and brachial plexus/ulnar nerve protectionReport a problem with this question

12. 12. In the lateral position a roll is placed under the dependent thorax just below the axilla. What does it accomplish?

    • A.It supports the lumbar spine so the kidney rest can be raised safely.
    • B.It lifts the dependent shoulder so the surgeon can reach the flank more easily.
    • C.It keeps the dependent arm from sliding off the armboard during the case.
    • D.It offloads the dependent axilla, protecting the brachial plexus and vessels.✓ Answer

    The axillary roll lifts the chest wall so that the patient's weight rests on the rib cage rather than on the axilla itself, keeping pressure off the brachial plexus and the axillary artery and vein of the dependent side. It is positioned below the axilla, not in it, because a roll pushed up into the axilla causes exactly the compression it is meant to prevent.

    Source: AST Standards of Practice for Surgical Positioning — lateral position and axillary rollReport a problem with this question

13. 13. After an alcohol-based skin prep, solution has run under the patient's flank and beneath the tourniquet cuff. What is done?

    • A.Blot the pooled solution with a counted sponge and begin the case.
    • B.Leave the solution to evaporate beneath the drapes while the team scrubs in.
    • C.Cover the wet area with a sterile towel and continue draping at once.
    • D.Remove the wet linen and let the skin dry fully before draping starts.✓ Answer

    Pooled alcohol prep is both a chemical burn hazard against skin held under a cuff or the patient's own weight and a fuel that releases flammable vapor, so the wet material is removed and the skin is allowed to dry completely before drapes go on and before any energy device is activated. Covering or blotting the pool traps the vapor under the drapes instead of letting it dissipate, and a counted sponge must never be diverted to mop prep solution.

    Source: AST Standards of Practice for Skin Prep and for surgical fire prevention — prep solution poolingReport a problem with this question

14. 14. Hair must be removed from a surgical site. Which method carries the lowest infection risk?

    • A.Shaving with a razor blade in the holding area on the morning of surgery.
    • B.Applying a depilatory cream to the site the night before surgery.
    • C.Clipping with an electric clipper as close to the surgical time as possible.✓ Answer
    • D.Shaving with a razor blade on the table once the drapes are in place.

    A razor cuts the skin surface and leaves microabrasions that bacteria colonize, and the longer the interval between shaving and incision, the more time that colonization has to build, so clipping close to the time of surgery produces the lowest infection rate. Depilatory creams avoid abrasion but cause contact reactions in some patients and are still applied far too early to help.

    Source: AST Standards of Practice for Skin Prep of the Surgical Patient — hair removal by clippingReport a problem with this question

15. 15. Where is the electrosurgical dispersive electrode (patient return electrode) placed?

    • A.Over the fat of the abdomen so the largest surface area is covered.
    • B.Over a large, well-vascularized muscle mass close to and on the side of the site.✓ Answer
    • C.Over a scarred area away from the site so the field is not disturbed.
    • D.Over a bony prominence near the site so the pad lies flat on the skin.

    Muscle has a high water content and conducts well, so a large muscle mass close to and on the same side as the operative site returns the current at a safely low density and over the shortest path; fat, scar and bone are poor conductors that concentrate current and cause burns. The pad is applied to clean, dry, hairless skin after final positioning, is never cut or reused, and is never placed distal to a tourniquet or over an implanted metal prosthesis.

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

16. 16. After a laparoscopic case a bowel burn is found well away from the operative site, and the shaft of the monopolar instrument has a small crack in its coating. Which hazard does this describe?

    • A.Insulation failure, in which current escapes through a break in the shaft covering.✓ Answer
    • B.Direct coupling, in which the active tip touches another uninsulated metal instrument.
    • C.Capacitive coupling, in which current passes through intact insulation to the cannula.
    • D.Alternate site burn, in which current returns through skin touching the metal table.

    A break in the insulation lets current leave the shaft at a point the surgeon cannot see, and because power at the tip does not drop there is no warning at all, which is why the injury often appears days later as perforation or peritonitis. The distinction matters: capacitive coupling transfers current through insulation that is still intact, while direct coupling requires the activated tip to contact another metal instrument, so only insulation failure fits a cracked shaft.

    Source: AST Standards of Practice for the Use of Electrosurgery — insulation failure in minimally invasive surgeryReport a problem with this question

17. 17. During a head and neck procedure a drape ignites at the surgical site. What is the team's immediate priority?

    • A.Activate the fire alarm and begin moving the patient out of the room.
    • B.Stop the flow of gases and remove the burning drape from the patient.✓ Answer
    • C.Ask the circulator to call for help while the surgeon finishes the step.
    • D.Reach for the extinguisher and discharge it onto the burning drapes.

    A fire on the patient is fought by attacking the fire triangle at the patient: the anaesthesia provider stops the oxidizer while burning material is pulled off the patient and doused with saline, all of which happens before alarms or evacuation. Around the head and neck the oxygen-enriched atmosphere makes the drapes burn faster and hotter, so seconds spent finishing a surgical step or fetching an extinguisher are seconds of direct thermal injury.

    Source: AST guidelines for surgical fire prevention and response — fire on the patient: stop the oxidizer, remove and extinguish burning materialReport a problem with this question

18. 18. Everyone inside the nominal hazard zone of a surgical laser must wear which eye protection?

    • A.Any polycarbonate safety glasses with side shields kept in the room.
    • B.Clear face shields, since they cover the eyes and the rest of the face.
    • C.Wavelength-specific goggles of the correct optical density, with side shields.✓ Answer
    • D.Prescription glasses worn over contact lenses, which absorb the beam.

    Laser eyewear works by absorbing one specific band of wavelengths to a stated optical density, so protection is only valid for the laser actually in use and eyewear for a different wavelength offers no protection at all. Ordinary safety glasses, clear shields and contact lenses do not attenuate the beam, and the eye is the organ most at risk because the injury is instantaneous and painless.

    Source: AST Guidelines for Best Practices in Laser Safety — wavelength-specific protective eyewear within the nominal hazard zoneReport a problem with this question

19. 19. An unlabeled basin of clear fluid is found on the back table during the procedure. What is done with it?

    • A.The solution is used anyway, since only saline was passed to the field.
    • B.The solution is labeled now from what the circulator remembers giving.
    • C.The solution is discarded and a fresh, labeled amount is obtained.✓ Answer
    • D.The solution is identified by odor and then labeled for use.

    Every medication and solution on the sterile field is labeled with name, strength and concentration the moment it is received, and anything unlabeled is by definition unidentified, so it is discarded and replaced rather than reconstructed from memory. Clear fluids on a field can include saline, water, local anaesthetic, contrast or an irrigant with an additive, and identifying them by smell or by assumption is how wrong-drug injections happen.

    Source: AST Standards of Practice for medication and solution handling on the sterile field — immediate labeling; discard unlabeled containersReport a problem with this question

20. 20. A lymph node specimen is being passed off the sterile field. How is this done correctly?

    • A.Se pasa sobre una gasa radiopaca ya contada y se mantiene húmeda hasta entregarlo.
    • B.It is passed dry in the surgeon's glove and labeled after the case ends.
    • C.It is passed in formalin as a frozen section and named at the next count.
    • D.It is passed on a nonradiopaque pad, with type and site confirmed aloud.✓ Answer

    A specimen carried on a counted radiopaque sponge corrupts the count and can be thrown away with the sponge, so a nonradiopaque pad is used and the technologist, circulator and surgeon confirm the tissue type and its exact source aloud as it leaves the field. The specimen is kept moist and never allowed to dry, but a frozen section goes fresh to pathology and must not be placed in preservative, and labeling is never left until after the case.

    Source: AST Standards for Handling and Care of Surgical Specimens — transfer, moisture, and verbal verification of sourceReport a problem with this question

21. 21. Which finding is the earliest and most sensitive sign of malignant hyperthermia?

    • A.A widening pupil that responds slowly to the anesthesia provider's light.
    • B.A core temperature above 40 degrees Celsius on the esophageal probe.
    • C.A rising end-tidal carbon dioxide that does not fall with more ventilation.✓ Answer
    • D.A falling blood pressure with cool, mottled skin over the chest and the limbs.

    Malignant hyperthermia is a runaway rise in skeletal muscle metabolism, so carbon dioxide production climbs long before heat accumulates, and an end-tidal carbon dioxide that keeps rising despite increased ventilation is the earliest reliable warning, usually with tachycardia and masseter rigidity. The temperature rise that gives the syndrome its name is a late finding, and waiting for it costs the time in which dantrolene, cooling and cessation of the triggering agent are most effective.

    Source: AST Standards of Practice for malignant hyperthermia / MHAUS — hypercarbia as the earliest sign, hyperthermia as a late signReport a problem with this question

22. 22. While loading a needle the scrubbed technologist sustains a needlestick through the glove. What is done first?

    • A.Change the glove and finish the step, then report the stick after closing.
    • B.Squeeze the puncture to make it bleed, then cover it with a sterile dressing.
    • C.Cover the glove with a sterile bandage and continue until relief arrives.
    • D.Step back from the field, remove the glove, and wash the site with soap and water.✓ Answer

    The injured person leaves the field at once, degloves and washes the wound with soap and running water, because immediate decontamination is the only step that reduces inoculum, after which relief scrubs in and the exposure is reported so that source testing and prophylaxis can begin within the window in which they work. Squeezing the wound is not recommended, and continuing to work with a breached glove exposes both the technologist and the patient.

    Source: OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030 — immediate washing and reporting of a percutaneous exposureReport 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 →