NCCT CST End of Procedure Tasks

When the time comes to close the wound, along with a loaded needle holder, what should the surgical tech hand the surgeon?

Forceps appropriate for the depth, tissue, and needle type being used.

How does a surgical technician facilitate staple placement during skin closure?

By using forceps to evert the skin layer, aiding in the placement of staples.

What is the suture at the secondary suture line called?

Retention suture

These are examples of surgical tissue closure methods, except which one?’

A. Absorbable and non-absorbable sutures

B. Synthetic and stainless steel staples

C. Incision adhesives - butyl-2-cyanoacrylate

D. Subdermal micro-magnetic sealers

Subdermal micro-magnetic sealers

Which of these options is an example of an absorbent dressing? 

Abdominal pad

Which of the following should be prepared for a mastoid dressing?

Several fluffed sponges and rolled gauze

The following are reasons to apply sterile wound dressings over an incision site at the end of a procedure, except which one?

A. To prevent contamination.

B. To provide a surface for the scab to attach.

C. To absorb exudate from the wound.

D. To provide support for the surgical area.

To provide a surface for the scab to attach.

The patient has just had a procedure to remove a bunion from their foot.  Aside from dressings, what will the patient commonly leave the OR with?

A post-operative shoe or boot 

Which cast type is often applied to children that immobilizes unilateral or bilateral hips and femurs?

Spica

What is the duty of the surgical tech while assisting the surgeon during splint application?

Handing supplies such as splints, padding materials, bandages, and scissors.

Which option is included in a post-operative debrief, along with notifying PACU? 

The patient has vaginal packing that needs to be removed before going home.

What should be done when a total joint implant falls to the floor during the surgical procedure?

Request a new implant.

Which of the following actions should the surgical tech and circulating nurse take to ensure the sterility of the specimen handoff?

The tech should handle the specimen container by its sterile outer surface.

Why is it important for you (the TS-C) to be aware of how much local the patient has been given from the back table?   [Select 3]

The amount is reported to the nurse at the end of the case for the patient record.

The amount should be reported to another tech if you are relieved in the middle of a case.

The doctor may ask you at any time how much local they’ve been given.

What does the RN assess by weighing soiled sponges after use in a procedure on a neonate?

Blood loss

Why is accurate documentation of medication and solution usage vital in surgical settings?

To monitor patient response to medications and adjust dosages in real-time.

After completing a laparoscopic cholecystectomy, the patient is waking up and the surgical tech notices what appears to be hives developing on the patient's neck and chest. Shortly after, the patient starts having difficulty breathing. What should the surgical tech do?

Notify the anesthesia provider immediately, they may be having an allergic reaction.

While removing the drapes, the surgical tech recognizes some bleeding through the surgical dressing. Which of the following should be the surgical tech’s FIRST step?

Apply pressure and notify the surgeon immediately.

What action should a surgical tech take upon noticing bleeding at the surgical site after the dressing has been applied?

Notify the surgeon immediately.

Which of the following should the surgical technologist label on the basin and syringe if the surgeon decides that he wants 1% Lidocaine for the end of the case? (Select the three (3) correct answers.)

expiration date, drug name, strength

Which of the following information must be verified between the circulator and surgical technologist when dispensing medications onto the sterile field?  (Select the three (3) correct answers.)

name of the medication, expiration date, strength

Which of the following can be omitted from counts of a laparoscopic case? (Select the three (3) correct answers.)

A. laparoscopic instruments

B. trocars

C. Raytec sponges

D. suture needles

E. Veress needle

laparoscopic instruments, trocars, Veress needle

Which of the following information should be listed when labeling medications on the sterile field? [Select 3]

strength, name, expiration date

An orthopedic surgeon asks for pop-off sutures during the closure of a total hip replacement. The circulator asks the surgical technologist for an items count. Place the locations below in the correct count order. (Click and drag the options in the left column to their correct position in the right column.)

sterile field, Mayo, back table, off sterile field

Which of the following information should the surgical technologist place on the drug label when receiving local anesthetics onto the surgical field from the circulator? [Select 3]

drug name, expiration date, drug strength

Which of the following information should the surgical technologist report to the anesthesia provider for blood loss calculation?

amount of irrigation used

During surgery the circulating nurse provides medication to the surgical technologist. The surgical technologist should confirm which of the following? (Select the three (3) correct answers.)

The medication name, The concentration of the medication, Medication expiration date 

A surg tech just finished assisting a long carotid endarterectomy where the patient was experiencing bleeding issues. The anesthesiologist has begun the extubation process. Shortly after, the patient starts coughing violently and the incision site becomes engorged with blood. What should the tech do?

Notify the circulating nurse and maintain a sterile back table.

The surgical technologist is applying dressings after a thyroidectomy.  The surgical technologist notices swelling at the incision site.  This is most likely due to 

a hematoma.

At the closing of an exploratory laparotomy, the surgical technologist notices a tear on the back table drape. The surgical technologist will need to change the wound classification to which of the following?

Class III

Surgical site infections have been traced to bacteria from which of the following?

Hair, scalp, and skin

Which of the following are signs and symptoms of malignant hyperthermia? (Select the three (3) correct answers.)

tachycardia, muscle stiffness or rigidity, unstable or elevated blood pressure

The patient has just had an anterior cervical discectomy and fusion. After the patient coughs hard; the incision site starts to expand quickly.  The patient is now having trouble breathing.  Which of the following has the patient most likely developed?

hematoma.

Which of the following positions should a patient be placed in following a tonsillectomy in order to prevent post-operative aspiration?

Lateral

Which of the following is the appropriate number of staff required when moving the patient from the operating table to the stretcher?

four

After the incision was closed and the drapes were pulled off, the surgical technologist noticed a rash on skin with bumps and hives around the adhesive tape used to cover the dressing. Which of the following actions should the technologist take once the physician diagnoses the problem?

Remove the adhesive tape, rinse the skin and choose another type of dressing.

Which of the following suture material is most commonly used for wound closure in the presence of infection?

stainless steel

A general surgeon is preparing to close a patient’s abdomen. The patient has increased swelling and the surgeon has informed the surgical team that he will need to reinforce the closure. Which of the following materials should the technologist retrieve to prepare for the closure?

nylon suture and bolsters

Bolsters are placed around sutures to help alleviate pressure that the suture strand places on the skin, and will be needed in any incision where excess swelling or pressure is present. The other sutures will not help with reinforcing the incision for closure.

Which of the following is the surgeon likely to ask the surgical technologist to do during skin closure?

approximating

to help bring skin edges together to help the surgeon while he’s suturing

The surgeon begins to suture and asks the surgical technologist to assist with a continuous suture. The surgical technologist should

follow the suture.

Following a suture is when the surgical technologist holds the lower quarter of the suture taut and away from the incision so the doctor can suture. The suture has already been handed to the surgeon when he asks the surgical technologist to assist with following the suture. Cutting the suture is done after the surgeon has sewn the incision.

A surgical technologist starts a surgical procedure with 1000cc/ml of normal saline on the back table. At the end of the procedure, the surgical technologist has 300cc/ml of normal saline on the back table and there is 1500cc/ml of fluid in the suction canister.  Which of the following is the estimated blood loss for the patient during this procedure?

800cc/ml

If starting with 1,000 cc’s and then ended with 300 cc’s, that means 700 was used and should be in the suction canister. If there’s 1,500 cc’s in the canister and only 700 cc’s of that is saline, that means the remaining 800 cc’s should be blood.

At what point does the surgical technologist activate a Hemo-Vac drain?

when the incision is closed

The drain should not be opened until is toward the end of the case. After the surgeon closes the incision, you can activate the drain by compressing the reservoir and attaching the drainage tube to it. It cannot be activated until the drain is placed in the wound.

The circulator introduces additional lap sponges to the sterile field intraoperatively. The surgical tech should

audibly and visually verify that the right amount of sponges were opened.

For the circulating nurse to dispense a drug on a sterile area, what should the tech do to avoid contamination?

Place a sterile cup near the edge of table.

The surgical technologist is given 0.25% of Marcaine plain, 30ml/cc and 1% of lidocaine with epinephrine, 20ml/cc. The surgeon asks for a 50/50 mix of the medication in a 20ml/cc syringe. She hands back the syringe with 10ml/cc remaining.  How much of each medication was injected?

5ml/cc of Marcaine and 5ml/cc of lidocaine

10 mL’s of each drawn up into a 20 cc syringe makes a 50/50 mix. If 10 mL’s remain, that means only 5 mL’s of each medication remains in the syringe.

The physician will be injecting local anesthetic for a circumcision on a 16-year-old male.  Which is the correct medication for this procedure?

0.5% Marcaine 10mL Exp Mar 2020

Bupivicaine is the generic name for Marcaine, which is a local anesthetic. Marcaine without epinephrine is the best choice because epinephrine causes vasoconstriction

A patient has just undergone a triple bypass surgery and is in route to recovery when the nurse notices excessive bleeding. The patient is immediately returned to operating room.  The OR has already been broken down.  Place the following steps in the correct order.  (Click and drag the options to their correct order.)

Gather instruments and supplies.

Open a new setup.

Scrub.

Gown and glove self.

Gown and glove the surgeon.

While waiting for the patient to wake up and move over to the hospital bed to be transferred to PACU, the surgical technologist notices the drain is filling up quickly and the dressings are saturated. What should the surgical technologist do?

Call the physician back in the room

During the closing count on an abdominal case, the surgeon decides to use a malleable retractor.  When the retractors are counted, one is missing.  The surgeon maintains it was given back to the surgical technologist.  Which of the following actions should the surgical team take next?

The nurse and surgical technologist immediately begins searching for the item throughout the area.

Place the options below in the correct sequence for disposable drape removal at the end of a laparoscopic cholecystectomy.   (Click and drag the options in the left column to their correct position in the right column.)

A sterile towel is placed over the sterile dressing.

Hold the sterile towel over the sterile dressing.

Roll drapes down toward the feet pulling it over the dressing.

Throw drapes in correct biohazard bag.

What is the proper order to set up dressings on a Mayo at the end of a basic case?

Suture, wet sponge, dry sponge, xeroform, dressing sponges, tegaderm

An orthopedic surgeon requested a Hemovac drain during a total knee replacement procedure due to excessive fluid drainage. At the end of the procedure, the surgeon asked the surgical technologist to activate the drain. The technologist should connect the distal end of the drain to

Reservoir

The reservoir must be activated by first compressing it and creating negative pressure within it. This allows room for fluid to drain into the reservoir.

Place the options below in the correct order for removing and discarding patient drapes. (Click and drag the options to their correct position.)

Stabilize the dressings with a towel

Roll the drape downward to contain blood and other waste.

Switch hands and continue to roll the drape over the incision area.

Place the drape in a designated receptacle.

Remove the incision towels and clips.

When should sterile dressings be added to the sterile field to assist in wound closure?

immediately following wound closure and completion of a final count

The primary function of a pressure dressing is to

absorb drainage from the wound.

The primary function of a pressure dressing is to cause compression of the surgical wound so it can absorb drainage.