Ultimate CST Practice Exam: Questions,
Answers, and In-Depth Rationales
ULTIMATE CST PRACTICE EXAM (QUESTIONS 1–80)
SECTION 1: PREOPERATIVE PREPARATION
1. A 72-year-old patient with a history of diabetes is scheduled for a femoral-
popliteal bypass. Which of the following preoperative assessment findings
would be most concerning and should be reported to the surgeon immediately?
• A. Blood glucose of 140 mg/dL
• B. Serum creatinine of 2.8 mg/dL
• C. Hemoglobin of 11.5 g/dL
• D. Potassium of 4.2 mEq/L
Answer: B. Serum creatinine of 2.8 mg/dL
Rationale: A creatinine of 2.8 mg/dL indicates significant renal impairment.
Contrast dye used during angiography or the stress of major vascular surgery can
precipitate acute kidney injury. Normal creatinine is 0.6–1.2 mg/dL. The glucose of
140 is mildly elevated but acceptable for a diabetic; hemoglobin of 11.5 is low but
not an acute emergency; potassium of 4.2 is within normal limits.
2. The surgical technologist is reviewing the surgeon's preference card for a total
hip arthroplasty. Which of the following is the MOST appropriate patient
position for this procedure?
• A. Supine with a sandbag under the ipsilateral hip
, • B. Lateral decubitus with the operative hip up
• C. Prone with the hips flexed
• D. Lithotomy with both legs in stirrups
Answer: B. Lateral decubitus with the operative hip up
Rationale: The lateral decubitus position (operative side up) provides the best
access to the hip joint for a posterior or lateral approach. The unaffected leg is
supported, and the operative leg is prepped and draped free. Supine is used for
anterior approaches but is less common; prone and lithotomy are not used for
hips.
3. A patient is allergic to latex. Which of the following actions by the CST is
MOST critical to prevent an intraoperative reaction?
• A. Use powder-free gloves only
• B. Ensure all instruments are titanium
• C. Verify that all latex-containing products are removed from the sterile field
• D. Administer IV Benadryl preoperatively
Answer: C. Verify that all latex-containing products are removed from the sterile
field
Rationale: The most critical action is to eliminate all latex from the field, including
gloves, drains, catheters, tourniquets, and electrode pads. Powder-free gloves still
contain latex. Titanium instruments are irrelevant to latex allergy. Benadryl is an
adjunct but does not replace source removal.
4. The CST is setting up the back table for a carotid endarterectomy. Which of the
following medications should be readily available on the field for local
irrigation?
• A. Heparinized saline
, • B. Lidocaine with epinephrine
• C. Bacitracin solution
• D. Sterile water
Answer: A. Heparinized saline
Rationale: Heparinized saline is used to irrigate the carotid artery during clamping
to prevent thrombus formation. Lidocaine with epinephrine is not used in carotid
surgery due to the risk of vasoconstriction and cerebral ischemia. Bacitracin is for
wound irrigation, not vascular.
5. The surgeon requests a "five-minute time-out" prior to incision. What is the
PRIMARY purpose of this protocol?
• A. To allow the anesthesia provider to administer antibiotics
• B. To confirm the correct patient, procedure, site, position, and implants
• C. To perform a final instrument count
• D. To review the patient's allergy history
Answer: B. To confirm the correct patient, procedure, site, position, and
implants
Rationale: The universal time-out is a mandatory safety check immediately before
incision. It verifies the "five Ps": patient, procedure, site, position, and presence of
implants/special equipment. Counts are done separately, and allergies are verified
during the pre-op phase.
6. A patient is scheduled for an emergent appendectomy. The patient's last meal
was 2 hours ago. Which of the following is the MOST appropriate action?
• A. Delay the surgery for 6 hours
• B. Proceed with surgery but place a nasogastric tube
, • C. Proceed with rapid sequence intubation
• D. Cancel the case due to aspiration risk
Answer: C. Proceed with rapid sequence intubation
Rationale: In emergent surgery, the risk of a ruptured appendix (peritonitis/sepsis)
outweighs the aspiration risk. Rapid sequence intubation with cricoid pressure is
performed to protect the airway. Delaying is not appropriate in an emergency.
7. Which of the following hair removal methods is recommended by AORN for
surgical site preparation?
• A. Shaving with a razor the night before
• B. Shaving with a razor immediately before surgery
• C. Clipping with electric clippers immediately before surgery
• D. Using a depilatory cream the morning of surgery
Answer: C. Clipping with electric clippers immediately before surgery
Rationale: Clipping with electric clippers immediately before surgery (or in the
pre-op area) is the standard of care. Shaving causes micro-abrasions that increase
infection risk, especially if done the night before. Depilatory creams can cause
allergic reactions.
8. The pre-operative skin prep for a total knee replacement should include which
of the following antiseptics for optimal efficacy?
• A. 70% isopropyl alcohol alone
• B. Chlorhexidine gluconate with alcohol
• C. Hydrogen peroxide
• D. Normal saline with betadine
Answers, and In-Depth Rationales
ULTIMATE CST PRACTICE EXAM (QUESTIONS 1–80)
SECTION 1: PREOPERATIVE PREPARATION
1. A 72-year-old patient with a history of diabetes is scheduled for a femoral-
popliteal bypass. Which of the following preoperative assessment findings
would be most concerning and should be reported to the surgeon immediately?
• A. Blood glucose of 140 mg/dL
• B. Serum creatinine of 2.8 mg/dL
• C. Hemoglobin of 11.5 g/dL
• D. Potassium of 4.2 mEq/L
Answer: B. Serum creatinine of 2.8 mg/dL
Rationale: A creatinine of 2.8 mg/dL indicates significant renal impairment.
Contrast dye used during angiography or the stress of major vascular surgery can
precipitate acute kidney injury. Normal creatinine is 0.6–1.2 mg/dL. The glucose of
140 is mildly elevated but acceptable for a diabetic; hemoglobin of 11.5 is low but
not an acute emergency; potassium of 4.2 is within normal limits.
2. The surgical technologist is reviewing the surgeon's preference card for a total
hip arthroplasty. Which of the following is the MOST appropriate patient
position for this procedure?
• A. Supine with a sandbag under the ipsilateral hip
, • B. Lateral decubitus with the operative hip up
• C. Prone with the hips flexed
• D. Lithotomy with both legs in stirrups
Answer: B. Lateral decubitus with the operative hip up
Rationale: The lateral decubitus position (operative side up) provides the best
access to the hip joint for a posterior or lateral approach. The unaffected leg is
supported, and the operative leg is prepped and draped free. Supine is used for
anterior approaches but is less common; prone and lithotomy are not used for
hips.
3. A patient is allergic to latex. Which of the following actions by the CST is
MOST critical to prevent an intraoperative reaction?
• A. Use powder-free gloves only
• B. Ensure all instruments are titanium
• C. Verify that all latex-containing products are removed from the sterile field
• D. Administer IV Benadryl preoperatively
Answer: C. Verify that all latex-containing products are removed from the sterile
field
Rationale: The most critical action is to eliminate all latex from the field, including
gloves, drains, catheters, tourniquets, and electrode pads. Powder-free gloves still
contain latex. Titanium instruments are irrelevant to latex allergy. Benadryl is an
adjunct but does not replace source removal.
4. The CST is setting up the back table for a carotid endarterectomy. Which of the
following medications should be readily available on the field for local
irrigation?
• A. Heparinized saline
, • B. Lidocaine with epinephrine
• C. Bacitracin solution
• D. Sterile water
Answer: A. Heparinized saline
Rationale: Heparinized saline is used to irrigate the carotid artery during clamping
to prevent thrombus formation. Lidocaine with epinephrine is not used in carotid
surgery due to the risk of vasoconstriction and cerebral ischemia. Bacitracin is for
wound irrigation, not vascular.
5. The surgeon requests a "five-minute time-out" prior to incision. What is the
PRIMARY purpose of this protocol?
• A. To allow the anesthesia provider to administer antibiotics
• B. To confirm the correct patient, procedure, site, position, and implants
• C. To perform a final instrument count
• D. To review the patient's allergy history
Answer: B. To confirm the correct patient, procedure, site, position, and
implants
Rationale: The universal time-out is a mandatory safety check immediately before
incision. It verifies the "five Ps": patient, procedure, site, position, and presence of
implants/special equipment. Counts are done separately, and allergies are verified
during the pre-op phase.
6. A patient is scheduled for an emergent appendectomy. The patient's last meal
was 2 hours ago. Which of the following is the MOST appropriate action?
• A. Delay the surgery for 6 hours
• B. Proceed with surgery but place a nasogastric tube
, • C. Proceed with rapid sequence intubation
• D. Cancel the case due to aspiration risk
Answer: C. Proceed with rapid sequence intubation
Rationale: In emergent surgery, the risk of a ruptured appendix (peritonitis/sepsis)
outweighs the aspiration risk. Rapid sequence intubation with cricoid pressure is
performed to protect the airway. Delaying is not appropriate in an emergency.
7. Which of the following hair removal methods is recommended by AORN for
surgical site preparation?
• A. Shaving with a razor the night before
• B. Shaving with a razor immediately before surgery
• C. Clipping with electric clippers immediately before surgery
• D. Using a depilatory cream the morning of surgery
Answer: C. Clipping with electric clippers immediately before surgery
Rationale: Clipping with electric clippers immediately before surgery (or in the
pre-op area) is the standard of care. Shaving causes micro-abrasions that increase
infection risk, especially if done the night before. Depilatory creams can cause
allergic reactions.
8. The pre-operative skin prep for a total knee replacement should include which
of the following antiseptics for optimal efficacy?
• A. 70% isopropyl alcohol alone
• B. Chlorhexidine gluconate with alcohol
• C. Hydrogen peroxide
• D. Normal saline with betadine
