Operating Room Procedures and Sentinel Events, Exams of Nursing

Download Operating Room Procedures and Sentinel Events and more Exams Nursing in PDF only on Docsity! 1 Fuller: Surgical Technology: Principles and Practice, 7th Edition Mock Certification Exam 1. A patient is having surgery to repair a torn rotator cuff. Which of the following structures are the tendons of the rotator cuff attached to? a. Ulna b. Symphysis c. Humerus d. Clavicle ANS: C Rationale: The tendons of the rotator cuff are attached to the humerus with sutures or anchor suturing devices. 2. “Any unexpected occurrence involving death or serious physical or psychological injury or the risk there of” a. Perjury b. Sentinel event c. Incident d. Practice act ANS: B Rationale: A sentinel event is “Any unexpected occurrence involving death or serious physical or psychological injury or the risk there of” to the patient. 3. Who is authorized to sign the informed surgical consent for a patient who is not mentally competent or is incapacitated?? a. Patient b. Anesthesiologist c. Agency representative 2 d. Patient’s friend ANS: C Rationale: If a patient is mentally incompetent or incapacitated a responsible guardian, agency representative or court representative may sign the informed consent. 4. Which stage of grief is a patient in when he or she begins to state: “Just let me live to see my daughter finish school?” a. Bargaining b. Depression c. Denial 5 a. With sterile gauze b. With a clamp c. Throw into the kick bucket d. Throw away into sharps container ANS: A Rationale: Bullets should be carefully handled; they should be placed on a clean gauze and passed off the sterile field. The surgical technologist should avoid any contact of the bullet with any other metal, as metal could scratch the bullet, and obscure evidential marks. 9. To keep airborne contamination in the OR to a minimum, how many maximum air changes should take place? a. 40 per hour b. 20 per hour c. 10 per hour d. 30 per hour ANS: B Rationale: The CDC recommends that ORs be ventilated with at least a minimum of 15 and a maximum of 20 air changes per hour. 10. When using a laser, which precaution is best to use? a. Have sterile saline available b. Have a fire team available c. Place dry towels around the operative site d. Place wet towels around the operative site ANS: D Rationale: Wet towels are placed around the operative site to prevent burns in the area from the laser beam. 6 11. Escherichia coli resides on humans in the lumen of the . a. intestines b. esophagus c. ureters d. urethra ANS: A Rationale: E. coli are resident bacteria of the gastrointestinal tract. 12. The most commonly transmitted pathogen in the OR is . 7 a. Candida albicans b. Mycobacterium tuberculosis c. Staphylococcus aureus d. Pseudomonas aeruginosa ANS: C Rationale: S. aureus normally resides on healthy skin, but when transmitted to the surgical wound by direct or indirect contact can cause infection. S. aureus is the most wide spread cause of surgical site infections. 70% of people are skin carriers of S. aureus 13. A patient has just been found to have a postsurgical infection. Which source is most likely the primary means of infecting this patient? a. Contamination during the case b. SSI from the patient’s own skin c. The patient is a cigarette smoker d. The surgical team did not wear a hair cover ANS: B Rationale: The primary source for SSI is from the patient’s own skin. 14. The ST has just passed a new #10 blade to the surgeon to make the first incision on the skin. The surgeon has requested a #10 blade again. What should the ST do? a. Pass the same #10 blade. b. Change the blade to a new blade and pass. c. Give the surgeon a new #15 blade. d. Tell the surgeon that you are unsure of what to do. ANS: B Rationale: Instruments that come into contact with the skin of the patient should not be reused. 10 Rationale: Decontamination before the first procedure of the day or at any time includes cleaning any blood or body fluids present on OR walls. 19. Who should dispose of sharps from the back table at the end of a case? a. Environmental services b. Circulator c. Anesthesia technologist d. ST ANS: D Rationale: It is the ST’s responsibility to dispose of sharps after a surgical case is complete. 11 20. When is the best time to schedule a dirty case? a. At any time b. As the first case c. At the end of the day d. After lunch time ANS: C Rationale: Most facilities will schedule a dirty case as the last procedure of the day in an OR so that a thorough cleaning process will occur. 21. Which position is used for a breast augmentation? a. Lithotomy b. Trendelenburg c. Kraske d. Dorsal recumbent ANS: D Rationale: The dorsal recumbent (supine position) or Beach chair (Fowler) position is used to provide access to the chest/breast area). 22. Which of the following is a monofilament suture? a. Monocryl b. Mersilene c. Silk d. Vicryl ANS: A Rationale: Monocyl (polyglicaprone 25 is a monofilament suture.) 12 23. Which instrument would be used to hold a bone in place during an orthopedic procedure? a. Balfour b. Babcock c. Lowman d. Heaney ANS: C Rationale: The Lowman is a bone-holding forceps used to hold bones in place. 24. Which of the following destroys bacterial spores? 15 28. When placing an instrument in a plastic-paper peel pouch why should air be evacuated from the pouch before it is sealed? a. The package could rupture during sterilization. b. Air in the peel pouch is necessary for sterilization to occur c. Air in the peel pouch is essential for the instrument d. No precautions are necessary when peel pouching ANS: A Rationale: When placing an instrument in a plastic-paper peel pouch, air should be evacuated from the pouch before it is sealed to prevent the package rupturing in the sterilizer. 29. Which two factors contribute to the killing of microbes? a. Time and heat b. Moisture and heat c. Pressure and time d. Temperature and time ANS: B Rationale: Microbes are killed by a combination of moisture and heat. 30. Which bacteria is used for biological monitoring for steam sterilizers? a. Bacillus subtilis b. Staphyllococcus aureus c. Staphylococcus epidermidis d. Geobacillus stearothermophilus ANS: D Rationale: Geobacillus stearothermophilus is the bacteria used for biological monitoring of steam sterilization. 16 31. As PMMA (bone cement) hardens, it can cause: a. embolism . b. pulmonary hypertension. c. vasoconstriction. d. cardiac arrhythmias. ANS: A Rationale: As PMMA (bone cement) hardens within long bone, it can expand, causing intramedullary pressure which can force marrow tissue into the circulation, resulting in embolism. 17 32. What solution should the ST use to clean instruments at the point of use? a. Saline b. Sterile water c. Cidex d. Sodium hypochlorite ANS: B Rationale: Sterile water should be used because it will not corrode or cause damage to the instruments. 33. When a case cart full of dirty instruments arrives in the decontamination area, what is the first step that should be taken? a. Place in ultrasonic washer b. Place in washer-sterilizer c. Sorting instruments d. Soaking ANS: C Rationale: After arriving in the decontamination area from the procedure, the instruments are sorted. Instruments must be disassembled into parts and separated by weight and complexity before decontamination. 34. How often should a Bowie-Dick test be run? a. With each load b. Every other load c. Weekly d. Daily 20 a. Hasson trocar b. Pneumatic tourniquet c. CO2 gas tank d. Veress needle ANS: B Rationale: The pneumatic tourniquet is not an insufflation device; it is used to restrict blood flow to the surgical site. 39. An example of a nonfenestrated drape is a/n . a. stockinette b. laparotomy drape c. thyroid drape 21 d. craniotomy drape ANS: A Rationale: A stockinette is a nonfenestrated drape that is custom designed to cover a specific area. 40. A passive drain used within the biliary system is called a . a. Penrose b. nephrostomy tube c. Hemovac d. T-tube ANS: D Rationale: A T-tube is used within the biliary system to drain bile, via gravity, into a bile bag. 41. Which biopsy needle would be used to obtain cells from a breast lesion? a. Dorsey b. Chiba c. Franklin-Silverman d. Tru-Cut ANS: D Rationale: The Tru-Cut biopsy needle is used to obtain tissue from the breast. 42. Which of the following suture is absorbable? a. Prolene b. Silk c. Nylon d. Vicryl 22 ANS: D Rationale: Vicryl is a synthetic absorbable suture that absorbs in approximately 2 to 3 weeks. 43. When passing a loaded suture into the hand of a surgeon, what should the ST do with the trailing end of the suture? a. Let it hang free. b. Place a tag on it. c. Hold on to it. d. Place it in the surgeon’s hand. 25 d. a and c ANS: D Rationale: The purpose of double gloving is to reduce the risk of glove failure, reduce the risk of bloodborne pathogens to healthcare workers and microbial contamination of the surgical site, and it makes it easier to detect a puncture in the glove. 48. When opening sterile supplies, which should be opened first? a. Ring basin pack b. Back table pack c. Instrument set(s) d. Gown and gloves ANS: B Rationale: Because of its central location, it is recommended that the back table pack be opened first. 49. A sponge count has been performed, and the ST and circulator counted nine x- ray detectable (Ray-Tec) sponges. There should be 10 Ray-Tecs per package. What should the next step be? a. Hand those sponges off to the circulator to be bagged. b. Throw the sponges in the trash and request more. c. Keep the Ray-Tecs on the field and inform the patient. d. Complete a sentinel event form and give it to the manager. ANS: A Rationale: The ST should always hand the sponges of incorrect count off to the circulator, and the circulator will bag the sponges and keep them in a secluded spot in the OR until the case is done. 50. The only test that guarantees that an item is sterile is called a . 26 a. biologic indicator b. mechanical indicator c. chemical indicator d. Bowie-Dick test ANS: A Rationale: The ONLY test that guarantees that items are sterile and the conditions necessary for sterilization have been met is the biologic indicator. 51. In how many hours can a rapid read steam biologic indicator be read? a. 10 hours 27 b. 1 to 4 hours c. 12 hours d. 8 hours ANS: B Rationale: Rapid read biological monitoring for both high pressure steam and EO sterilization, results can be obtained in 1 to 4 hours depending on the sterilization process. 52. The spore used as a biologic indicator for EO is . a. Bacillus stearothermophilus b. Staphylococcus aureus c. Bacillus subtilis d. Geo stearothermophilus ANS: C Rationale: B. subtilis is the microbe that has been determined to be the most resistant to EO; it is harmless to humans. 53. An instrument tray is not necessary during a surgical procedure and is removed from the sterile field. Where should these instruments go from there? a. To the case cart outside the OR b. Stay in the OR until the case is over c. To decontamination d. Into the flash sterilizer ANS: B Rationale: No instruments should be removed from the OR during the procedure. 54. When transporting a surgical patient on a stretcher, how should the stretcher be positioned on an elevator? 30 a. air b. water c. saline d. lubricant ANS: B Rationale: Sterile water must be used because saline and lubricant will damage the catheter material, making it possible for air to escape from the balloon and cause an embolism. 59. Once sterile gloves have been donned, what is the next step during Foley catheterization? 31 a. Frog-leg the female patient b. Insert the catheter c. Cleanse the meatus d. Test the catheter’s balloon ANS: D Rationale: The balloon may be fully inflated to test for leakage, and then the fluid is withdrawn, prior to lubricating the tip of the catheter 60. How is the head positioned when positioning the patient in Trendelenburg? a. The head is down. b. The head is up. c. The head is hyperextended. d. The head is turned to the side. ANS: A Rationale: The Trendelenburg position is a modification of the supine position in which the head and upper body are in a downward position. 61. The patient undergoing a pilonidal cystectomy will be placed in which position? a. Fowler b. Lithotomy c. Kraske d. Lateral ANS: C Rationale: The Kraske (jackknife) position is a modification of the prone position used to access the anus and pilonidal area. 62. Which skin prep area should be prepped first? 32 a. Axilla b. Umbilicus c. Anus d. Vagina ANS: B Rationale: Certain areas are considered contaminated and should be prepped last except for these exceptions: mucous membranes, stomas, nonintact skin, sinus tracts, and umbilicus. 63. Which skin areas are to be prepped during a total hip arthroplasty? 35 c. Remove it with a hemostat and hand it to the circulator. d. Allow the circulator to remove it and redrape. ANS: C Rationale: Foreign bodies (such as hair) should be grasped with a hemostat and handed off to the circulator. Then the area should be covered. 68. When passing a suture to the surgeon, the ST should ensure that the point of the suture is . a. facing up b. facing the ST c. facing the ceiling d. facing the back table ANS: A Rationale: The ST should orient the needle so the point of the needle is facing up so that the surgeon can use the suture and not adjust it. 69. In which order should the intraoperative count be performed on the sterile field? a. Back table, ring basin, operative field, and Mayo stand b. Operative field, Mayo stand, back table, ring basin and items off the field c. Mayo stand, ring basin, back table, and operative field d. Kick bucket, ring basin, Mayo stand, and back table ANS: B Rationale: The sequence of counting is sterile operative field, Mayo stand, back table, and basin. It should be followed by the ST when counting all sharps, sponges, and instruments, however counting is dependent on institutional policy and can also be counted in the opposite order beginning with items off the field, ring basin, back table, mayo stand then items in the operative field. 70. Which incision is used to access the spleen? 36 a. McBurney’s b. Subcostal c. Inguinal d. Paramedian ANS: B Rationale: The right subcostal (Kocher) incision is the best incision for access to the spleen. 71. During a Nissen fundoplication, who introduces the Maloney or Bougie dilators? 37 a. The ST b. The surgeon c. The circulating nurse d. The anesthesia provider ANS: D Rationale: Maloney or Bougie dilators cannot be inserted from the sterile field; they are passed down the esophagus by the anesthesia provider. 72. In all procedures involving the intestine what precautions are taken with bowel technique? a. Wipe off the instruments and gloved hands with a fresh lap sponge. b. Place the instruments used on the colon back into the instrument tray. c. Instruments used on the bowel are kept separate from all other sterile items. d. Throw the used instruments into the kick bucket; rescrub, gown, and glove; and start over. ANS: C Rationale: Contaminated supplies are confined to the mayo stand and a designated basin. Before the wound is closed the surgical team dons fresh gloves and gowns. 73. Which of the following is a rectal speculum?? a. Vienna b. Graves c. Killian d. Pratt ANS: D Rationale: The bivalve Pratt is a rectal speculum. 40 a. Laparotomy tray b. Thyroid tray c. Vascular tray d. Tracheotomy (trach) tray ANS: D Rationale: The trach tray should be transported with the thyroidectomy patient to PACU due to possible bilateral cord paralysis. 79. What needs to be kept with the patient following a tracheostomy? a. Obturator 41 b. Wire scissors c. Poole suction d. Trousseau dilator ANS: A Rationale: The obturator of the tracheotomy tube is kept with the patient as long as the tracheal tube is in place. If the tube becomes dislodged or is traumatically removed the obturator is needed to replace the tube. 80. The fallopian tube, ovary and their ligaments are collectively called . a. vulva b. adnexa c. genitalia d. organs ANS: B Rationale: The uterine appendages (adnexa) are the fallopian tube, ovary and their ligaments. 81. Which drug does not cause uterine contractions? a. Epinephrine b. Oxytocin c. Carboprost d. Dinoprostone ANS: A Rationale: Epinephrine (adrenalin) causes vasoconstriction of vessels, resulting in reduced blood flow. 82. What is the most common reason for a cesarean section? 42 a. Placenta previa b. Placental abruption c. Previous cesarean section d. Failure to progress ANS: D Rationale: Prolonged labor or failure to progress is the most common reason for a cesarean section. 83. In which position will the patient be placed for Shirodkar’s procedure? a. Supine 45 b. Manometer c. Speculum d. Caliper ANS: D Rationale: A caliper may be used to measure the distance from the original point of insertion of the muscle to the new one. 88. During an anterior vitrectomy which of the following is a viscoelastic solution used to reform the anterior chamber of the eye? a. Mannitol b. Healon c. BSS d. Saline ANS: B Rationale: Healon is a viscoelastic solution used to reform the anterior chamber of the eye 89. Which instrument is used to remove cerumen from the external auditory canal during myringotomy? a. Baron suction b. Rosen pick c. Alligator forceps d. Buck curette ANS: D Rationale: After placement of a speculum, any visible cerumen accumulation is removed with a curette. 90. Why is the operating table reversed during myringotomy? 46 a. To allow the surgeon to sit b. To allow for placement of the tube c. For better visualization d. For easier access ANS: A Rationale: The operating table is typically reversed to accommodate the seated surgeon and equipment such as the microscope. 91. A patient has been diagnosed with otosclerosis causing hearing loss. What surgical procedure would be performed for this diagnosis? 47 a. Stapedectomy b. Mastoidectomy c. Tympanoplasty d. Myringotomy ANS: A Rationale: Stapedectomy, also called ossicular chain reconstruction, is the surgical treatment of choice to treat profound hearing loss related to sclerosis of the stapes, often caused by cholesteotoma for patients with otosclerosis. 92. Delicate microscopic instrumentation should be free of lint. The preferred material for removing lint is . a. a paper towel b. a cloth towel c. a gauze sponge d. a micro wipe ANS: D Rationale: Use of a micro wipe is recommended and preferred for cleaning instruments, rather than other materials, to keep the items free of lint. 93. Compressed pieces of Gelfoam squares are packed into the external auditory canal and mastoid cavity during mastoidectomy using . a. Russian forceps b. alligator forceps c. takahashi forceps d. cupped forceps ANS: B Rationale: Alligator forceps and a Gimmick are used to pack the mastoid cavity with soaked Gelfoam pieces during mastoidectomy. 50 a. Nd: YAG b. Holmium: YAG c. Carbon dioxide d. Argon gas ANS: C Rationale: The most popular laser for laryngeal procedures is the carbon dioxide laser; it can be combined with a microscope so that the beam can be focused. 99. Which of the following is a self-retaining mouth gag? a. Wieder 51 b. McIvor c. Fisher d. Beckman ANS: B Rationale: The McIvor is a self-retaining mouth gag used to prop open the mouth and push the tongue down. 100. The definitive treatment for intractable snoring is called . a. parotidectomy b. tonsillectomy c. polysomnography d. uvulopalatopharyngoplasty (UPPP) ANS: D Rationale: UPPP is the definitive treatment for snoring and obstructive sleep apnea. 101. After passing the biopsy forceps during rigid laryngoscopy, what is the best method of removing tissue specimen from the jaws of the biopsy forcep? a. A Ray-Tec sponge b. A hypodermic needle c. A mosquito clamp d. A lukens trap ANS: B Rationale: A hypodermic needle is the best method for removing tissue samples gently from the biopsy forcep. 102. The most common type of midfacial fracture is . a. Le Fort I 52 b. Le Fort II c. Le Fort III d. Zygomatic ANS: A Rationale: The Le Fort I fracture is the most common type of midfacial fracture. It is a transverse fracture of the maxilla. 103. Which is the graft material using cadaver bone? a. Autograft b. Polymer c. Allograft 55 Rationale: Sterile mineral oil is often used for lubrication during removal of split- thickness skin to reduce friction. 108. When switching from a dirty to a clean case, whose gloves should be changed first? a. Surgeon b. Assistant c. Resident d. Scrub ANS: D Rationale: The scrub’s gloves should be changed first or the gloves of all other team members will be contaminated. 109. Which of the following scissors would be used during a rhinoplasty procedure? a. Jorgensen b. Tenotomy c. Metzenbaum d. Potts ANS: B Rationale: Tenotomy scissors are used mostly during rhinoplasties to trim the upper lateral cartilage and free the periosteum and perichondrium. 110. When performing a breast reconstruction at the same time as mastectomy, what should be the main concern of the ST? a. Do the case as quickly as possible. b. Wipe all instruments after use. c. Get a new set of sterile supplies. d. Help reposition the patient. 56 ANS: C Rationale: Fresh sterile supplies are necessary when performing the reconstruction portion to prevent the spread (seeding) of cancer cells. 111. What type of graft is a performed during a TRAM flap procedure? a. Pedicle graft b. Free flap c. Partial thickness graft d. Full thickness graft ANS: A 57 Rationale: The transverse rectus abdominis (TRAM) flap procedure is performed to reconstruct the breast without use of implants. The TRAM flap is a pedicle graft. 112. Which gland is responsible for secreting epinephrine and norepinephrine? a. Pineal b. Pituitary c. Apocrine d. Adrenal ANS: D Rationale: The adrenal gland, which sits on top of each kidney, is responsible for secreting epinephrine and norepinephrine. 113. The notched area on the medial side of each kidney is called? a. Gerota’s fascia b. Hilium c. Medulla d. Renal pyramids ANS: B Rationale: The hilium is the notched area on the medial side of each kidney 114. Which of the following surrounds the urethra and secretes an alkaline fluid that contributes to seminal fluid? a. Vas deferens b. Seminal vesicles c. Bulbourethral gland d. Prostate gland ANS: D 60 Rationale: The distal penis should be loosely wrapped in petroleum gauze to prevent trauma to the tissues during removal. 119. Which dilators should the ST have available during a penile prosthesis procedure? a. Hegar b. Heaney c. Hanks d. Van Buren ANS: A Rationale: Hegar dilators are used to dilate the corpora cavernosum and corpora spongiosum during penile implant procedures. 61 120. Which prostatectomy approach requires the use of the cysto room? a. Perineal b. Urethral c. Suprapubic d. Retropubic ANS: B Rationale: The urethral approach requires the use of the cysto room because a high volume of fluids is used and the cysto room is equipped with a built-in drainage system. 121. Which sterile irrigation fluid should be used during a cysto procedure in which an electrosurgical unit will be used? a. Dextrose b. Saline c. Glycine d. Water ANS: C Rationale: Glycine is a non-electrolytic and isotonic irrigant that will not affect the use of the ESU. 122. In which direction should an extremity be wrapped for exsanguination before inflation of a pneumatic tourniquet? a. Distal to proximal b. Proximal to distal c. Side to side d. Up and down ANS: A 62 Rationale: The surgeon will exsanguinate an extremity by elevating the extremity and wrapping it distally to proximally with an Esmarch or Ace bandage. 123. What should be done when a total joint implant falls to the floor during the surgical procedure? a. Flash sterilize the implant. b. Soak the implant in Cidex. c. The case should be discontinued. d. Request a new implant for use. ANS: D 65 128. Which instrument would not be a part of an above-the-knee amputation procedure? a. Key elevator b. Liston knife c. Gigli d. Herrick clamp ANS: D Rationale: The Herrick clamp is a kidney clamp that is used during most open genitourinary procedures. 129. Which nerve is relieved of pressure during a carpal tunnel release? a. Radial nerve b. Median nerve c. Ulnar nerve d. Carpal nerve ANS: B Rationale: The median nerve is relieved of pressure by releasing the transverse carpal ligament. 130. Which position is used for Achilles tendon repair? a. Prone b. Lateral c. Jackknife d. Fowler ANS: A Rationale: The patient is positioned in the prone position for Achilles tendon repair due to the location of the Achilles tendon. 66 131. How is the alignment of the great toe and the metatarsal head joint maintained after bunionectomy? a. Compression plates b. Steinmann pins c. Self-tapping screws d. Non-absorbable suture ANS: B Rationale: Alignment of this joint is maintained by placing two Steinmann pins across the metatarsal joint. 67 132. Which retractor is most commonly used during rotator cuff repair procedures? a. Hohman b. Beckman c. Charnley d. Greenburg ANS: A Rationale: The Hohman is the retractor used during rotator cuff repair. 133. What should the ST do when the surgeon is using a powered drill? a. Watch the drilling b. Suction the plume c. Irrigate the area d. Sponge the area ANS: C Rationale: Irrigate the area that is being drilled to keep the tissue cool and remove debris. 134. A rotator cuff tear usually occurs where the tendon inserts into the humerus. a. Glenoid b. Teres minor c. Subscapularis d. Supraspinatus ANS: D Rationale: A rotator cuff tear usually occurs where the supraspinatus tendon inserts into the humerus. 70 a. Jackson-Pratt b. Hemo-Vac c. Pleur-Evac d. Penrose ANS: C Rationale: The Pleur-Evac drainage system will be used because the chest tube that is placed can be connected to the closed water-seal system. 140. Which is the incision for CABG surgery?? a. Midline 71 b. Median sternotomy c. Lateral d. Posterolateral ANS: B Rationale: CABG is performed through a median sternotomy incision 141. When the ST passes a suture to the surgeon performing end-to-side anastomosis of the saphenous vein to the aorta, what should be the next best step? a. Irrigate the wound b. Tag the suture c. Place a clamp on the aorta d. Wet the surgeon’s hands ANS: D Rationale: When the surgeon is using fine sutures to perform an anastomosis, the surgeon’s hands should be wet with saline, by the ST, to prevent breaking the suture. 142. Why is it important for the patient undergoing cardiopulmonary bypass to become hypothermic at some point during the procedure? a. To reduce oxygen demands of the heart b. Because this will reduce infections c. Because it will stop the heart d. To create a bloodless site ANS: A Rationale: When the patient’s temperature is dropped, this will reduce the oxygen demand on the myocardium of the heart by half. 143. Which instrument may be used to remove the plaque from the arterial wall during carotid endarterectomy? 72 a. Cobb b. Freer c. Joker d. Gerald ANS: B Rationale: The Freer elevator is commonly used to lift/elevate the plaque up and out after it has been freed from the arterial wall. 144. During an endarectomy which carotid arteries are occluded? a. Iliac, internal, external 75 c. Cerebrospinal fluid d. Salivary secretions ANS: C Rationale: CSF is the likely fluid draining from the nose after a brain injury—it appears clear in nature. 149. Which self-retaining retractor would be used in cranial procedures? a. Scoville b. Weitlaner c. Adson-Beckman d. Leyla-Yasargil ANS: D Rationale: The Leyla-Yasargil is a self-retaining retractor used on most open procedures involving the brain. 150. In which position would a patient be placed for access to a parietal lobe tumor? a. Prone b. Supine c. Lateral d. Sitting ANS: B Rationale: The supine position is used for access and exposure of the frontal, parietal, and temporal lobes. 151. Why is the hip slightly elevated during positioning the patient for anterior cervical discectomy and fusion? a. For access to iliac crest 76 b. To take pressure off the vena cava c. To relieve extruding disk pressure d. For better visualization of the spine ANS: A Rationale: For ACDF, the hip is slightly elevated for iliac crest bone procurement. 152. How should the ST care for the bone flap removed during a craniotomy? a. By placing it in a basin of sterile water b. By wiping the bone with a wet sponge c. By placing it in a basin of antibiotic solution d. Pass the bone off the field to store in the freezer 77 ANS: C Rationale: The ST should place the bone flap in a basin of antibiotic solution to reduce infection risk when replacing the bone flap. 153. How is bleeding from the dura controlled during craniotomy? a. With bone wax b. With 4-0 Nurulon c. With antibiotic saline d. With bipolar bayonet ANS: D Rationale: The bipolar bayonet is an electrocautery device used for hemostasis of moist and/or delicate tissues. 154. How is the shaved hair handled from a patient undergoing craniotomy? a. Discarded into the trash b. Placed in a biohazard bag c. Sent to pathology as specimen d. Kept as patient property ANS: D Rationale: The shaved hair from a patient should be placed in a plastic bag and saved for the patient. 155. Intracranial pressure (ICP) is measured during a shunt procedure using . a. a manometer b. a sphygmomanometer c. a Doppler 80 ANS: B Rationale: Nurolon suture is the suture of choice when closing the dura mater layer in many neuro procedures. 160. Which instrument should the ST have ready for retraction of the nerve root during laminectomy? a. Meyerding b. Beckman c. Gelpi d. Love 81 ANS: D Rationale: The Love nerve root retractor is the retractor that should be ready for use in retracting the spinal nerve root and dura. 161. Which rongeur should the ST have ready for the removal of disk material during lumbar laminectomy? a. Pituitary b. Leksell c. Kerrison d. Ruskin ANS: A Rationale: The pituitary rongeur is the preferred rongeur for removal of fragmented disk material during lumbar laminectomy. 162. Which tissue, removed during laminectomy, is passed off of the sterile field as specimen? a. Disk b. Ligamentum flavum c. Lamina d. Spinal cord ANS: A Rationale: Disk material/tissue is removed from the rongeur by the ST and passed off of the field as specimen. 163. What structures are contained in the hernia sac seen in myelomeningocele? a. Spinal cord and vertebrae b. Vertebrae and CSF c. Spinal cord, meninges, and nerve roots d. Meninges and vertebrae 82 ANS: C Rationale: The structures that are contained within a hernia sac seen in myelomeningocele patients are the spinal cord, meninges and nerve roots. 164. The goal of conflict resolution in the OR is to attempt to: a. win the argument. b. gossip about the problem. c. find a solution. d. become friends with everyone. 85 169. One of the leading causes of burnout among team members in the OR is . a. sexual assault b. gossip c. verbal abuse d. groupthink ANS: C Rationale: Verbal abuse is one of the leading causes of burnout among team members in the OR. 170. One of the most effective ways to counteract verbal abuse in the OR is by . a. becoming aggressive b. keeping quiet c. becoming assertive d. using sarcasm ANS: C Rationale: Assertive behavior is one of the most effective ways to counteract verbal abuse. 171. Which of the following is not a characteristic of good teamwork in the OR? a. Yielding b. Groupthink c. Politeness d. Collaboration ANS: B 86 Rationale: Groupthink occurs when a group is polarized in their thinking, opinions, and means of expression; they are the “in crowd” and people that are not in with them are the “out crowd.” Therefore, groupthink is not a good characteristic of teamwork in the OR. 172. Which organization oversees certification and credentialing of STs? a. NBSTSA b. ARC/STSA c. CAAHEP d. AST ANS: A 87 Rationale: The NBSTSA (formerly LCC-ST) is responsible for eligibility, granting, revoking, and denial of certification. 173. A patient death has occurred in the OR, and a family member of the patient has asked the ST about the patient. Which of the following is the best step to take in this situation? a. Tell the family member that the patient has died. b. Defer any discussion about the patient to the doctor. c. Contact the hospital chaplain for advice on what to say. d. Avoid the deceased patient’s family members. ANS: B Rationale: The ST should refrain from providing information to family or friends about the patient’s medical condition; this is the responsibility of the doctors and nurses. 174. Which of the following tissues cannot be procured from a non-heart beating cadaver? a. Cornea b. Bone c. Heart d. Skin ANS: C Rationale: To sustain the viability for later transplantation, the heart must be procured from a heart beating cadaver. 175. When passing medication in a syringe to a surgeon’s hand, the ST should first: a. take the cap off the needle. b. state the name and strength. c. ask for a hypodermic needle. d. ask the circulating nurse for help.