22 Surgical Procedures Practice Questions & Answers

1. 1. In a midline laparotomy, which layer is divided immediately after the linea alba and before the peritoneum is entered?

   • A.The transversalis fascia, with preperitoneal fat below it✓ Answer
   • B.The transversus abdominis muscle belly, the innermost layer
   • C.The fascia of Scarpa, the membranous subcutaneous layer
   • D.The external oblique aponeurosis, forming the rectus sheath

   On the midline the rectus muscles are not cut: the fused aponeuroses form the linea alba, and deep to it lie only the transversalis fascia, preperitoneal fat and peritoneum. Camper's and Scarpa's fasciae were already passed above the linea alba, so the next structures the technologist expects to see are the transversalis fascia and fat.

   Source: Alexander's Care of the Patient in Surgery, abdominal wall layers in laparotomyReport a problem with this question

2. 2. Which layer of the bowel wall holds the suture in an intestinal anastomosis?

   • A.The muscularis propria, whose fibers drive peristalsis
   • B.The serosa, the smooth outer covering of the bowel
   • C.The submucosa, the strongest layer because of its collagen✓ Answer
   • D.The mucosa, whose glandular lining seals the lumen

   The submucosa is dense collagenous connective tissue and is the strongest layer of the gut wall, so it is the layer that anchors a suture and must be included in every bite of an anastomosis. Serosa and mucosa tear out under tension, and the muscularis alone will not hold.

   Source: Alexander's Care of the Patient in Surgery, intestinal anastomosis techniqueReport a problem with this question

3. 3. During abdominal hysterectomy, which structure lies immediately beneath the uterine artery where it is clamped at the cervix?

   • A.The ureter, passing under the artery beside the cervix✓ Answer
   • B.The ovarian artery, descending in the infundibulopelvic ligament
   • C.The obturator nerve, running along the lateral pelvic wall
   • D.The round ligament, running toward the inguinal canal

   The ureter crosses beneath the uterine artery about two centimeters lateral to the cervix, the relationship taught as water under the bridge. That is why the artery is skeletonized and clamped close to the uterus and why the technologist keeps the ureter in view during this step.

   Source: Alexander's Care of the Patient in Surgery, total abdominal hysterectomy anatomyReport a problem with this question

4. 4. A groin hernia sac that emerges medial to the inferior epigastric vessels is classified as:

   • A.A femoral hernia, passing under the inguinal ligament into the canal
   • B.A direct hernia, pushing through the floor of Hesselbach's triangle✓ Answer
   • C.A pantaloon hernia, with sacs on both sides of those vessels
   • D.An indirect hernia, entering through the deep inguinal ring

   Hesselbach's triangle is bounded by the inferior epigastric vessels laterally, the inguinal ligament inferiorly and the lateral edge of the rectus medially. A sac bulging medial to those vessels comes through that weak floor and is direct, while an indirect sac follows the cord through the deep ring lateral to the vessels.

   Source: Alexander's Care of the Patient in Surgery, inguinal herniorrhaphy anatomyReport a problem with this question

5. 5. A curved clamp with longitudinal jaw serrations and a single opposing tooth at the tip is being used to secure vascular pedicles. It belongs to which procedure?

   • A.Bowel resection, for occluding the intestine before division
   • B.Open cholecystectomy, for the cystic duct before ligation
   • C.Thyroidectomy, for the superior thyroid pole vessels
   • D.Hysterectomy, for the uterine and cardinal ligament pedicles✓ Answer

   That jaw pattern describes the Heaney clamp, designed so the terminal tooth keeps a thick vascular pedicle from slipping while the ligature is placed. It is used on the uterine vessels and the cardinal and uterosacral ligaments in hysterectomy, not on duct, bowel or thyroid tissue.

   Source: Nemitz, Surgical Instrumentation: clamping and occluding instruments, Heaney clampReport a problem with this question

6. 6. The surgeon asks for the clamp used to dissect behind the cystic duct and draw a tie around it. You pass:

   • A.A right-angle clamp, whose fine tip draws the tie behind✓ Answer
   • B.An Allis clamp, whose short interlocking teeth hold tissue
   • C.A Babcock clamp, whose broad flared jaw is atraumatic
   • D.A curved Kelly clamp, whose heavier jaw grasps the duct

   A right-angle clamp has a fine tip bent ninety degrees, so it can be passed behind a duct or vessel, opened to receive the free end of a ligature and pulled back through, carrying the tie. Kelly, Babcock and Allis jaws are made to grasp, not to tunnel behind a structure.

   Source: Nemitz, Surgical Instrumentation: right-angle (Mixter) clamp applicationReport a problem with this question

7. 7. After the intercostal muscle is divided in a posterolateral thoracotomy, the technologist hands:

   • A.A wide malleable ribbon retractor shaped to the chest wall
   • B.A self-retaining rib spreader with a ratcheted crank arm✓ Answer
   • C.A self-retaining abdominal ring retractor with its blades
   • D.A handheld Deaver retractor for the edge of the diaphragm

   Once the pleura is entered the ribs must be spread and held apart to expose the lung, which is the job of a self-retaining rib spreader cranked open between the ribs. Ribbon, ring and Deaver retractors are abdominal or handheld tools and cannot maintain thoracic exposure.

   Source: Alexander's Care of the Patient in Surgery, thoracotomy exposure and rib spreaderReport a problem with this question

8. 8. During a lumbar laminectomy the surgeon must remove bone from the lamina edge overlying the nerve root. You hand:

   • A.A rongeur with a thin footplate that slides under the lamina✓ Answer
   • B.A Cobb elevator for stripping muscle from the spinous process
   • C.A pituitary rongeur with a long cupped jaw for disc material
   • D.A curved osteotome and mallet for cutting cortical bone

   A Kerrison-type rongeur has a thin footplate that slips into the canal beneath the lamina so bone is cut upward away from the dura and root. A pituitary rongeur removes disc, an osteotome cuts bone blindly, and a Cobb elevator only strips paraspinous muscle.

   Source: Alexander's Care of the Patient in Surgery, laminectomy instrumentationReport a problem with this question

9. 9. As the scalp flap is incised for a craniotomy, the technologist should have ready:

   • A.Scalp clips loaded on an applier to control the skin edge✓ Answer
   • B.Cottonoid patties moistened to protect the brain surface
   • C.Bone wax rolled into strips for the diploic bone edges
   • D.A perforator and craniotome for turning the bone flap

   The scalp is highly vascular and bleeds briskly the moment it is cut, so spring clips are applied to the everted skin edge as the incision is made. Bone wax, cottonoids and the power instruments are needed later, at the bone and dural stages of the case.

   Source: Alexander's Care of the Patient in Surgery, craniotomy scalp incision and hemostasisReport a problem with this question

10. 10. In plating a fracture, after the hole is drilled through both cortices, the technologist next passes:

    • A.The tap, so threads can be cut into the drilled hole
    • B.The screwdriver with the chosen cortical screw loaded
    • C.The drill sleeve for the next hole in the plate
    • D.The depth gauge, so the correct screw length can be read✓ Answer

    The sequence is drill, measure, tap, insert: the depth gauge hooks the far cortex so the screw length is known before threads are cut. Tapping or driving a screw before measuring risks a screw that is too short to hold or long enough to injure structures beyond the bone.

    Source: Alexander's Care of the Patient in Surgery, ORIF screw insertion sequenceReport a problem with this question

11. 11. In phacoemulsification, the step that immediately follows the capsulorhexis is:

    • A.Insertion of the folded intraocular lens into the bag
    • B.Injection of viscoelastic to reform the anterior chamber
    • C.Hydrodissection, separating the nucleus from the capsule✓ Answer
    • D.Creation of the clear corneal incision with a keratome

    Once the anterior capsule is opened, balanced salt solution is injected under its edge to free the nucleus from the cortex and capsule so it can rotate and be emulsified. The corneal incision and viscoelastic came before the rhexis, and the lens goes in only after the nucleus and cortex are removed.

    Source: Alexander's Care of the Patient in Surgery, phacoemulsification operative sequenceReport a problem with this question

12. 12. Two limbs of bowel have been joined with a linear cutting stapler. The technologist next prepares:

    • A.A linear stapler to close the common enterotomy site✓ Answer
    • B.A clip applier to secure the ends of the staple line
    • C.A circular end-to-end stapler with its anvil detached
    • D.A skin stapler to approximate the mesenteric defect

    In a functional end-to-end anastomosis the cutting stapler is introduced through enterotomies in the two limbs, and that shared opening must then be closed, classically with a noncutting linear stapler fired across it. A circular stapler is a different technique, and skin staples and clips have no role inside the bowel.

    Source: Alexander's Care of the Patient in Surgery, stapled functional end-to-end bowel anastomosisReport a problem with this question

13. 13. The surgeon announces conversion to an open cholecystectomy. The technologist's first action is to:

    • A.Send the gallbladder off the field so the container is ready
    • B.Open the laparotomy set and pass a knife for the incision✓ Answer
    • C.Hand the surgeon a fresh gown and gloves before incising
    • D.Break down the laparoscopic tower and clear the trocars

    Conversion is usually driven by bleeding or unclear anatomy, so speed matters: the open set kept in the room is opened at once and the knife for the subcostal incision is passed. Laparoscopic equipment is left in place until the surgeon is working openly, and specimen and gowning tasks wait.

    Source: Alexander's Care of the Patient in Surgery, conversion of laparoscopic to open cholecystectomyReport a problem with this question

14. 14. Before the telescope is introduced through the umbilical port, the technologist should:

    • A.Wipe the lens with dry gauze and set the light to minimum
    • B.White balance and focus the camera and warm the lens tip✓ Answer
    • C.Clip the light cable to the drape until the surgeon asks
    • D.Open the insufflation valve fully to exceed 20 mmHg pressure

    White balancing against a white sponge sets true color reference, focusing gives a sharp image at working distance, and warming the tip keeps it from fogging when it meets warm moist peritoneum. Dry gauze scratches the lens, minimum light blinds the view, and the pressure limit is set by the surgeon.

    Source: Alexander's Care of the Patient in Surgery, laparoscopic camera and telescope preparationReport a problem with this question

15. 15. When an instrument is exchanged in a docked robotic arm, it must be:

    • A.Advanced into the field under the surgeon's endoscopic view✓ Answer
    • B.Loaded by the circulator once the arm has been cleared
    • C.Placed through the port with tips open and wrist flexed
    • D.Inserted after the arm is undocked and then docked again

    A robotic instrument advanced blindly can perforate bowel or vessel outside the camera's view, so the tip is always brought in while the surgeon watches it on the endoscope. The instrument is loaded on the sterile field with tips closed and straight, and undocking for every exchange is unnecessary.

    Source: Alexander's Care of the Patient in Surgery, robotic instrument exchange safetyReport a problem with this question

16. 16. The incision most commonly made in the uterus at cesarean section is:

    • A.A vertical incision through the upper uterine body
    • B.A transverse incision in the lower uterine segment✓ Answer
    • C.A curved transverse incision above the pubic symphysis
    • D.An inverted-T incision across the fundus of the uterus

    The lower uterine segment is thin and relatively avascular, so a transverse incision there bleeds less, heals with a stronger scar and carries a lower risk of rupture in a later pregnancy than a classical vertical incision. The curved suprapubic incision describes the skin, not the uterus.

    Source: Alexander's Care of the Patient in Surgery, cesarean section uterine incisionReport a problem with this question

17. 17. During transurethral resection with a monopolar resectoscope, the irrigating solution used is:

    • A.Lactated Ringer's solution warmed to body temperature
    • B.Sterile distilled water, because it is clear and cheap
    • C.A nonelectrolytic solution such as glycine or sorbitol✓ Answer
    • D.Normal saline, because it conducts and cools the loop

    Monopolar current disperses in an electrolyte solution, so the irrigant must be nonconductive; glycine and sorbitol are isotonic nonelectrolyte solutions that keep the cutting current effective. Distilled water is nonconductive but hemolytic, and saline and Ringer's conduct and are reserved for bipolar resection.

    Source: Alexander's Care of the Patient in Surgery, TURP irrigation and TUR syndromeReport a problem with this question

18. 18. A specimen sent for frozen section leaves the sterile field:

    • A.In a dry labeled container, with no preservative added✓ Answer
    • B.In formalin, so the tissue is fixed before it is read
    • C.In a transport medium that keeps the cells viable
    • D.In saline-soaked gauze inside a sealed biohazard bag

    Frozen section requires unfixed tissue: formalin fixes and distorts the cells and makes an immediate diagnosis impossible, and it can render the margin unreadable. The specimen is therefore passed dry in an identified container and the identity and site are confirmed aloud with the circulator.

    Source: Alexander's Care of the Patient in Surgery, care and handling of frozen section specimensReport a problem with this question

19. 19. For anastomosis of a synthetic graft to the femoral artery, the technologist prepares:

    • A.Braided absorbable suture swaged to a reverse cutting needle
    • B.Braided nonabsorbable suture on a large cutting needle
    • C.Monofilament absorbable suture on a blunt-point needle
    • D.Double-armed monofilament nonabsorbable suture on taper needles✓ Answer

    Vascular anastomoses need permanent strength, a smooth surface that slides through the wall and does not wick bacteria, and a taper needle that spreads rather than slices the vessel. Double arming lets the surgeon sew in both directions from one point around the anastomosis.

    Source: Alexander's Care of the Patient in Surgery, vascular suture and needle selectionReport a problem with this question

20. 20. After a split-thickness skin graft is laid on the recipient bed, the dressing applied over it is:

    • A.A semi-occlusive film left in place for several days
    • B.A tie-over bolster that presses the graft onto the bed✓ Answer
    • C.A rigid plaster splint applied directly over the graft
    • D.A dry gauze dressing changed at the end of the case

    A graft has no blood supply of its own and survives by imbibition and then ingrowth of vessels, which fails if fluid or shear separates it from the bed. A tie-over bolster holds even contact and immobilizes the graft, while the semi-occlusive film belongs on the donor site.

    Source: Alexander's Care of the Patient in Surgery, split-thickness skin graft dressingsReport a problem with this question

21. 21. End-tidal carbon dioxide climbs sharply and the jaw becomes rigid soon after induction. While the team treats the patient, the scrubbed technologist should:

    • A.Break down the back table to clear room for the crisis cart
    • B.Begin closing the wound with the suture already loaded
    • C.Leave the field to obtain and reconstitute the dantrolene
    • D.Keep the field sterile, cover the wound, and remain ready✓ Answer

    Rising end-tidal carbon dioxide with masseter rigidity suggests malignant hyperthermia, a crisis managed by anesthesia and the circulator while the surgeon decides whether to abort or close. The scrub stays sterile and covers the wound with sterile towels, because the case may resume and the field must not be lost.

    Source: Alexander's Care of the Patient in Surgery, malignant hyperthermia intraoperative responseReport a problem with this question

22. 22. A major vessel is torn and the wound fills with blood. The scrubbed technologist's immediate action is to:

    • A.Hand the electrosurgical pencil and sponge the pooled blood
    • B.Step back from the field to give the surgeon more room
    • C.Provide suction and pass a folded lap sponge for packing✓ Answer
    • D.Open a chest tube tray in case the vessel is not controlled

    Bleeding is controlled first by pressure and by seeing the hole, so suction to clear the field and a folded sponge for direct packing come before anything else, with vascular clamps and suture readied next. Electrosurgery will not seal a torn major vessel, and stepping back leaves the surgeon without help.

    Source: Alexander's Care of the Patient in Surgery, intraoperative hemorrhage and the scrub roleReport 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 →