22 Surgical Procedures Practice Questions & Answers

1. 1. During a small bowel resection the surgeon must grasp and hold the bowel without crushing it. Which instrument should the CST pass?

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

   The Babcock has broad, fenestrated, rounded jaws with no teeth and only smooth longitudinal ridges, so it encircles and holds delicate tubular structures such as bowel, ureter, and fallopian tube with minimal crushing. Allis jaws carry short interlocking teeth, the Kocher/Ochsner has a traumatic 1x2 tooth at the tip, and the Rochester-Pean has heavy full-length crushing serrations; all three are used on tissue that will be removed or on pedicles to be ligated.

   Source: NBSTSA CST examination content outline, Intraoperative Procedures (instrumentation); Nemitz, Surgical Instrumentation — grasping and holding instrumentsReport a problem with this question

2. 2. An appendectomy reveals a perforated appendix with purulent fluid pooling throughout the pelvis. Which suction tip should the CST have ready?

   • A.Frazier suction tip
   • B.Andrews (tonsil) suction tip
   • C.Poole suction tip✓ Answer
   • D.Yankauer suction tip

   The Poole is a straight tube with a perforated outer guard that spreads the vacuum over many small openings, so it evacuates large volumes of fluid from a body cavity quickly without pulling omentum or bowel into a single port. The Frazier is a small angled tip with a stylet for neurologic, ENT, and plastic cases, while the Yankauer and Andrews tips are designed for the oropharynx and shallow fields.

   Source: NBSTSA CST examination content outline, Intraoperative Procedures (general surgery instrumentation); Alexander's Care of the Patient in Surgery — appendectomyReport a problem with this question

3. 3. The peritoneum has just been tented between two hemostats and incised during an exploratory laparotomy. What should the CST have ready to pass NEXT?

   • A.The skin stapler
   • B.A self-retaining abdominal retractor such as a Balfour✓ Answer
   • C.The dressing sponges
   • D.Backhaus towel clips

   Once the cavity is entered the surgeon's immediate need shifts from cutting to exposure, so the anticipated item is the self-retaining abdominal retractor (with moist laparotomy sponges to protect the wound edges and viscera). Anticipating the next step of the sequence is the core of the technologist's intraoperative role; the stapler and dressing belong to closure and the towel clips were used before the incision.

   Source: NBSTSA CST examination content outline, Intraoperative Procedures — anticipating the needs of the surgical team; Alexander's Care of the Patient in Surgery — laparotomyReport a problem with this question

4. 4. Why are dressing sponges kept separate and not opened onto the sterile field until skin closure is complete?

   • A.They are sterilized by a different method than counted sponges
   • B.They are not radiopaque and are not part of the counted sponges, so early introduction risks an untracked sponge entering the wound✓ Answer
   • C.They lose absorbency if opened too early in the case
   • D.They must first be moistened with warm saline

   Every sponge that may enter the wound must be radiopaque so it can be found on an X-ray, and it must be part of the counted supply; dressing sponges are neither, so mixing them into the field before the wound is closed creates the possibility of a retained item that no count and no film would reliably resolve. Keeping them off the field until skin closure is finished preserves the integrity of the count.

   Source: AST standards of practice for counts; Alexander's Care of the Patient in Surgery — sponge, sharp, and instrument countsReport a problem with this question

5. 5. A sponge count does not reconcile as wound closure begins. What is the CST's FIRST action?

   • A.Say nothing until radiology can be called for a film
   • B.Correct the count sheet and recount after the patient leaves the room
   • C.Assume the sponge went out with the discarded drapes and continue
   • D.Notify the surgeon immediately so closure is halted and the search begins✓ Answer

   The surgeon is the only person who can stop closure and re-explore the wound, so the incorrect count must be announced immediately, before the layer is closed over a possible retained item; the field, floor, linen, and trash are then searched and imaging is obtained according to the facility's policy. The count record is documented factually and is never altered to make the numbers balance.

   Source: AST standards of practice for counts — incorrect count procedure; facility policy governs the search and imaging stepsReport a problem with this question

6. 6. A breast mass is excised and the surgeon requests a frozen section. How should the CST hand the specimen off the field?

   • A.In a container of alcohol
   • B.On a counted radiopaque sponge until the pathologist arrives
   • C.Fresh — dry or on saline-moistened Telfa — with no fixative✓ Answer
   • D.In formalin, labeled with the patient's name and the site

   Formalin and alcohol fix and harden tissue, which destroys the cellular detail the pathologist needs to freeze, section, and read the specimen immediately, so a frozen section (like a culture) is sent fresh. The specimen must not be allowed to dry, must be identified with the patient, source, and laterality, and is never placed on a counted sponge, which would corrupt the count and risk loss of the specimen.

   Source: AST standards of practice for handling surgical specimens; Alexander's Care of the Patient in Surgery — specimen care and frozen sectionReport a problem with this question

7. 7. Bipolar forceps are used for hemostasis during a craniotomy. Why is no dispersive (return) electrode placed on the patient?

   • A.The head fixation device serves as the return path
   • B.The bipolar output is too low to require one
   • C.Current passes only between the two tips of the forceps and does not travel through the patient to a pad✓ Answer
   • D.Irrigation fluid grounds the circuit

   In bipolar electrosurgery the active and return functions are both built into the two tips, so the circuit is completed across the small volume of tissue held between them and no current flows through the rest of the patient to a dispersive pad. That confinement is also why bipolar is preferred on the brain, near nerves, and on appendages, where stray monopolar current could cause remote injury.

   Source: AST standards of practice for the use of electrosurgery; Kotcher, Surgical Technology: Principles and Practice — electrosurgical unitsReport a problem with this question

8. 8. A cortical screw is being placed through a plate during an ORIF of the forearm. In what order should the CST anticipate the steps?

   • A.Drill, measure with the depth gauge, tap, insert the screw✓ Answer
   • B.Drill, tap, insert the screw, measure
   • C.Tap, drill, measure with the depth gauge, insert the screw
   • D.Measure, tap, drill, insert the screw

   The hole must exist before it can be measured, so the sequence is drill the hole, measure it with the depth gauge to select the correct screw length, tap threads that match the screw, then insert the screw. Knowing this fixed order lets the technologist load the drill bit, hand the gauge, have the matching tap and screw of the measured length ready, and keep the case moving without the surgeon asking.

   Source: NBSTSA CST examination content outline, Intraoperative Procedures — orthopedic procedures; Alexander's Care of the Patient in Surgery — internal fixation techniqueReport a problem with this question

9. 9. A femoropopliteal bypass graft is about to be anastomosed to the artery. Which suture and needle should the CST have loaded?

   • A.Braided silk on a cutting needle
   • B.Chromic gut on a reverse-cutting needle
   • C.Plain surgical gut on a blunt needle
   • D.Double-armed polypropylene monofilament on a taper needle✓ Answer

   A taper point spreads the vessel wall rather than slicing it, so the needle hole seals around the suture instead of enlarging into a bleeding slit, and polypropylene is an inert nonabsorbable monofilament with no capillarity to harbor bacteria and no loss of strength over time in a permanent anastomosis. The double-armed configuration lets the surgeon run each end around one side of the anastomosis and tie in the middle; absorbable gut would fail the repair and cutting needles would perforate the artery.

   Source: Alexander's Care of the Patient in Surgery — peripheral vascular anastomosis; Kotcher, Surgical Technology: Principles and Practice — suture and needle selectionReport a problem with this question

10. 10. Bleeding forces a laparoscopic cholecystectomy to be converted to an open procedure. What is the CST's immediate responsibility?

    • A.Have the circulator open the open-procedure instrument set onto the field while the CST stays scrubbed and accounts for the added items✓ Answer
    • B.Wait and hand instruments only as the surgeon names each one
    • C.Leave the field to retrieve the open set personally
    • D.Break down the laparoscopic setup and send it out of the room first

    An open set, extra suction, laparotomy sponges, and a self-retaining retractor are kept in the room unopened precisely so a conversion can be handled in seconds, and the scrubbed technologist obtains them through the circulator without ever leaving or contaminating the sterile field. Items added during the case are accounted for with the circulator, and the laparoscopic instruments stay on the field until the case is stable rather than being broken down during active bleeding.

    Source: NBSTSA CST examination content outline, Intraoperative Procedures — responding to changes in the surgical plan; Alexander's Care of the Patient in Surgery — laparoscopic to open conversionReport a problem with this question

11. 11. Which nerve is MOST at risk when the lithotomy position is used without adequate padding?

    • A.Radial nerve in the spiral groove
    • B.Common peroneal nerve at the head of the fibula✓ Answer
    • C.Phrenic nerve
    • D.Ulnar nerve at the elbow

    In lithotomy the lateral aspect of the leg rests against the stirrup or post exactly where the common peroneal nerve wraps superficially around the head of the fibula with almost no soft tissue over it, and sustained compression there produces foot drop. Padding at that point, and raising and lowering both legs slowly and simultaneously to protect the hips and lumbar spine, are the technologist's positioning safeguards.

    Source: AST standards of practice for surgical positioning; Alexander's Care of the Patient in Surgery — lithotomy position and peripheral nerve injuryReport a problem with this question

12. 12. A patient is placed in the lateral (kidney) position for a nephrectomy. What is the purpose of the axillary roll?

    • A.To elevate the kidney rest under the flank
    • B.To keep the patient from rolling forward off the table
    • C.To lift the dependent chest wall and relieve pressure on the axillary vessels and brachial plexus of the DOWN arm✓ Answer
    • D.To support the upper arm at shoulder height

    The axillary roll is placed under the chest just caudad to the dependent axilla, not in the axilla, so that the weight of the thorax rests on the rib cage instead of compressing the axillary artery, vein, and brachial plexus of the arm against the table. Compression there causes ischemia and plexus injury of the down arm, which is the classic complication of this position.

    Source: AST standards of practice for surgical positioning; Alexander's Care of the Patient in Surgery — lateral (kidney) positionReport a problem with this question

13. 13. The prep area for a laparotomy includes an existing colostomy stoma. How should the skin prep be carried out?

    • A.Prep the stoma first, then the surrounding abdominal skin
    • B.Begin at the periphery and work toward the incision
    • C.Leave the stoma unprepped and simply drape it out
    • D.Begin at the intended incision and work outward in widening circles, prepping the stoma last with a separate sponge✓ Answer

    Prepping always moves from the cleanest area to the most contaminated: the antiseptic starts at the incision line and moves outward in concentric circles, and a sponge that has reached the periphery is discarded rather than brought back toward the center, so contamination is never carried inward. A stoma — like the umbilicus, vagina, and anus — is the most contaminated area in the field and is isolated and prepped last with its own sponge.

    Source: AST standards of practice for skin preparation of the surgical patient; Alexander's Care of the Patient in Surgery — surgical skin antisepsisReport a problem with this question

14. 14. Skin closure of the recipient site is complete at the end of a split-thickness skin graft procedure. What is the correct order of the next steps?

    • A.Apply and secure the dressing while the drapes are still in place, then lift the drapes away from the wound✓ Answer
    • B.Remove the drapes and the dressing sponges together in one motion
    • C.Remove the drapes, then apply the dressing
    • D.Remove the drapes, break down the back table, then dress the wound

    The dressing is applied while the drapes are still in place because the wound remains protected by the sterile field until it is covered; removing the drapes first exposes a fresh suture line and a new graft to airborne and skin contamination. The drapes are then lifted carefully away from the wound so that drains, catheters, and graft dressings are not dislodged.

    Source: NBSTSA CST examination content outline, Postoperative Procedures; Alexander's Care of the Patient in Surgery — dressing application and drape removalReport a problem with this question

15. 15. An orthopedic implant set is steam sterilized. Which monitor gives the only direct evidence that spores in that load were killed?

    • A.The external chemical process indicator on the outside of the package
    • B.The sterilizer printout of time, temperature, and pressure
    • C.A biological indicator containing bacterial spores✓ Answer
    • D.The Bowie-Dick test run that morning

    Only a biological indicator challenges the load with living, highly resistant spores, so a negative result after incubation is direct proof of lethality rather than an inference. The external chemical indicator shows only that the package was exposed to the process, the mechanical printout shows only that the cycle parameters were achieved in the chamber, and a Bowie-Dick test verifies air removal in a dynamic-air-removal sterilizer; an implant load is held until the biological indicator result is known.

    Source: AAMI and AORN principles for sterilization process monitoring — physical, chemical, and biological monitoring; biological indicators in implant loadsReport a problem with this question

16. 16. Under the Spaulding classification, a flexible endoscope that contacts only intact mucous membranes requires at minimum which level of processing?

    • A.High-level disinfection✓ Answer
    • B.Intermediate-level disinfection
    • C.Low-level disinfection
    • D.Cleaning with detergent only

    Spaulding classifies items by the risk of the tissue they touch: critical items that enter sterile tissue or the vascular system must be sterilized, semicritical items that touch mucous membranes or non-intact skin require at minimum high-level disinfection after thorough cleaning, and noncritical items touching intact skin need only low- or intermediate-level disinfection. Mucosa resists ordinary vegetative organisms but not the mycobacteria and viruses that high-level disinfection is designed to destroy.

    Source: Spaulding classification of patient-care items (CDC guideline for disinfection and sterilization in healthcare facilities)Report a problem with this question

17. 17. In a lower midline laparotomy, which layer is incised immediately after the subcutaneous tissue (Camper's and Scarpa's fascia)?

    • A.The anterior rectus sheath at the linea alba✓ Answer
    • B.The belly of the rectus abdominis muscle
    • C.The transversalis fascia
    • D.The peritoneum

    The midline traverses skin, subcutaneous tissue, the anterior rectus sheath fused in the midline as the linea alba, then the rectus muscles are separated rather than cut, followed by transversalis fascia, preperitoneal fat, and finally peritoneum. Knowing this fixed layer order is what lets the technologist anticipate the change from knife to dissecting scissors or electrosurgery, then retractors, then two hemostats to tent the peritoneum.

    Source: Tortora & Derrickson, Principles of Anatomy and Physiology — anterior abdominal wall; Alexander's Care of the Patient in Surgery — laparotomy incisionsReport a problem with this question

18. 18. Which layer of the bowel wall provides the tensile strength that holds sutures in an intestinal anastomosis?

    • A.Serosa
    • B.Submucosa✓ Answer
    • C.Muscularis externa
    • D.Mucosa

    The submucosa is a dense sheet of collagen and elastic fibers and is by far the strongest layer of the gut wall, so an anastomosis that does not incorporate it will pull through and leak. The mucosa is fragile and secretory, the muscularis tears under suture tension, and the serosa is a thin covering absent over parts of the bowel.

    Source: Tortora & Derrickson, Principles of Anatomy and Physiology — layers of the gastrointestinal wall; Alexander's Care of the Patient in Surgery — intestinal anastomosisReport a problem with this question

19. 19. During an abdominal hysterectomy the uterine artery is clamped just lateral to the cervix. Which structure lies immediately beneath it and is at risk?

    • A.The ureter✓ Answer
    • B.The obturator nerve
    • C.The round ligament
    • D.The common iliac vein

    The ureter passes underneath the uterine artery a short distance lateral to the cervix — the classic 'water under the bridge' relationship — so a clamp, tie, or energy device applied blindly at that point can crush, ligate, or burn it. The technologist supports the surgeon here by having the right-angle clamp, ties, and adequate suction and lighting ready so the artery can be skeletonized under direct vision.

    Source: Alexander's Care of the Patient in Surgery — abdominal hysterectomy; Tortora & Derrickson, Principles of Anatomy and Physiology — female pelvic anatomyReport a problem with this question

20. 20. An elective cholecystectomy is completed with no spillage of bile and no break in technique. How is this wound classified?

    • A.Class I, clean
    • B.Class II, clean-contaminated✓ Answer
    • C.Class IV, dirty-infected
    • D.Class III, contaminated

    The classification depends on whether a colonized tract was entered and under what control: the biliary tree is part of the alimentary tract, and entering it electively without unusual contamination is Class II. A Class I wound involves no entry into the respiratory, alimentary, genital, or urinary tracts at all, Class III involves gross spillage or a major break in technique, and Class IV means established infection or a perforated viscus.

    Source: CDC surgical wound classification, Classes I through IVReport a problem with this question

21. 21. Well into a general anesthetic the anesthesia provider announces a rapidly rising end-tidal CO2 with masseter rigidity and tachycardia. What should the scrubbed CST do?

    • A.Break scrub and begin dismantling the sterile field
    • B.Keep the sterile field intact, stay scrubbed, and prepare for rapid closure while the circulator brings the emergency cart✓ Answer
    • C.Leave the room to fetch ice
    • D.Draw up and hand the antidote from the sterile field

    A rapidly rising end-tidal CO2 is the earliest and most sensitive sign of malignant hyperthermia because the muscle becomes hypermetabolic long before the temperature climbs, and the crisis is managed by the anesthesia provider and circulator while the surgical team gets the patient closed as quickly as safely possible. The scrubbed technologist's own role is to protect the sterile field, anticipate rapid closure supplies and sterile cold irrigation, and keep the count and specimens in order; the technologist does not select or administer medication.

    Source: Howe & Burton, Pharmacology for the Surgical Technologist — malignant hyperthermia recognition and team response; NBSTSA CST examination content outline, emergency situationsReport a problem with this question

22. 22. Who is responsible for obtaining the patient's informed consent for a surgical procedure?

    • A.The anesthesia provider
    • B.The circulator
    • C.The surgeon who will perform the procedure✓ Answer
    • D.The surgical technologist

    Informed consent is a disclosure of the diagnosis, the proposed procedure, its risks, benefits, and alternatives, and only the physician who will perform the operation has the knowledge and the legal duty to make that disclosure. Other team members may witness the signature and confirm that the signed form is on the chart and was signed before sedating medication was given; obtaining consent is outside the surgical technologist's scope of practice.

    Source: Legal principles of informed consent as the operating surgeon's duty; AST standards addressing the surgical technologist's scope of practiceReport 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 →