NBSTSA CST COMPLETE EXAM PREP V2.0 –
CERTIFIED SURGICAL TECHNOLOGIST
Advanced-Level Practice Examination | 150
Questions | Detailed Rationales
TABLE OF CONTENTS
Section Title Questions
I Perioperative Care – Preoperative Preparation 1–25
II Perioperative Care – Intraoperative Procedures 26–75
III Perioperative Care – Postoperative Procedures 76–85
IV Ancillary Duties – Administrative & Personnel 86–95
V Ancillary Duties – Equipment Sterilization & Maintenance 96–110
VI Basic Science – Anatomy & Physiology 111–130
VII Basic Science – Microbiology & Infection Control 131–140
VIII Basic Science – Surgical Pharmacology & Anesthesia 141–150
SECTION I: PERIOPERATIVE CARE – PREOPERATIVE PREPARATION (Questions 1–25)
, Question 1
A 74-year-old patient with a history of chronic obstructive pulmonary disease (COPD), type 2
diabetes mellitus, and a 45-pack-year smoking history is scheduled for an open abdominal aortic
aneurysm repair. The surgical technologist is reviewing the surgeon's preference card and
preoperative orders. Which of the following combinations of interventions represents the MOST
comprehensive strategy to minimize this patient's risk of postoperative pulmonary
complications and surgical site infections?
A) Administer preoperative prophylactic vancomycin 2 hours prior to incision, maintain strict
NPO status for 12 hours, and position the patient in the Trendelenburg position during transport
to the OR.
B) Coordinate with the anesthesia provider for bronchodilator therapy, ensure appropriate
glycemic control with insulin sliding scale, encourage incentive spirometry education, and verify
that the preoperative antibiotic (cefazolin) is administered within 60 minutes of incision.
C) Restrict all oral fluids for 24 hours preoperatively, administer preoperative sedatives to
reduce anxiety, and apply sequential compression devices (SCDs) only after the patient is
anesthetized.
D) Shave the surgical site the night before surgery using a straight razor, administer broad-
spectrum antibiotics 4 hours prior to incision, and position the patient in the prone position for
the procedure.
CorreCt answer : B
Rationale: This patient has multiple risk factors for postoperative complications. COPD and
smoking history increase pulmonary risk, while diabetes increases infection risk. Optimal
management includes bronchodilator therapy for pulmonary optimization, glycemic control to
reduce infection risk, incentive spirometry education, and proper timing of prophylactic
antibiotics (within 60 minutes of incision). NPO for 24 hours is excessive and dangerous;
Trendelenburg positioning would impair respiration; shaving the night before increases infection
risk; and prone positioning is inappropriate for this procedure.
Question 2
The surgical technologist is preparing the operating room for a complex pediatric craniofacial
reconstruction. The patient is a 6-month-old infant with a documented allergy to latex and a
history of malignant hyperthermia in a sibling. Which of the following represents the MOST
comprehensive preoperative preparation strategy?
, A) Prepare the OR with standard equipment, keep a latex-free cart available outside the
room, and have dantrolene sodium readily accessible.
B) Ensure all latex-containing products are removed from the OR and implement a latex-safe
protocol, prepare the anesthesia machine by removing volatile anesthetic agents and have
dantrolene sodium immediately available, verify appropriate pediatric-sized equipment and
positioning devices, and participate in a thorough Time Out.
C) Use only powder-free latex gloves, maintain the OR temperature at 65°F, and have
succinylcholine available for malignant hyperthermia treatment.
D) Apply a sterile latex glove over a non-latex glove for double-gloving, use adult-sized
positioning devices with extra padding, and administer preoperative diphenhydramine for latex
allergy prophylaxis.
CorreCt answer : B
Rationale: This scenario involves multiple critical safety considerations. Latex allergy requires
complete removal of all latex-containing products from the OR. Malignant hyperthermia
susceptibility requires removal of triggering agents (volatile anesthetics and succinylcholine)
and immediate availability of dantrolene sodium. Pediatric patients require appropriately sized
equipment and positioning devices. The Time Out is essential for patient safety. Powdered
gloves are contraindicated in latex allergy. Double-gloving with latex still exposes the patient.
Adult-sized equipment is unsafe for a 6-month-old infant.
Question 3
During the preoperative verification process, the surgical technologist is participating in the
Universal Protocol Time Out. The circulating nurse reads the patient's name and date of birth,
the surgeon confirms the procedure, and the site is marked. However, the surgical technologist
notices that the consent form indicates a right-sided procedure, but the patient's imaging
reports and the surgical site marking indicate a left-sided procedure. What is the MOST
appropriate action?
A) Proceed with the procedure as the surgeon has confirmed the site marking.
B) Silently note the discrepancy and document it after the procedure.
C) Immediately speak up and halt the Time Out process, clearly stating the discrepancy
between the consent form, imaging, and site marking, and request clarification before
proceeding.
D) Inform the circulator privately after the Time Out is completed.
CorreCt answer : C
, Rationale: A discrepancy between the consent form, imaging, and surgical site marking
represents a critical safety issue that could lead to a wrong-site surgery. The surgical
technologist has a professional and ethical obligation to speak up immediately and halt the
process until the discrepancy is resolved. Patient safety supersedes concerns about hierarchy or
embarrassment. Proceeding with the procedure, ignoring the discrepancy, or addressing it after
the Time Out would be unsafe and unprofessional.
Question 4
The surgical technologist is performing the initial surgical hand scrub of the day using the
traditional brush method. Which of the following sequences represents the CORRECT
anatomical progression for the scrub technique?
A) Scrub the hands first, then the forearms, then the elbows, allowing water to run from the
elbows toward the hands.
B) Scrub the hands first, then the forearms, then the elbows, allowing water to run from the
hands toward the elbows.
C) Scrub the forearms first, then the hands, then the elbows, allowing water to run from the
elbows toward the hands.
D) Scrub the nails first, then the hands, then the forearms, then the elbows, allowing water
to run from the hands toward the elbows.
CorreCt answer : D
Rationale: The correct surgical scrub technique involves scrubbing the nails first (using a nail
cleaner), then the hands, then the forearms, and finally the elbows. Water must flow from the
cleanest area (hands) toward the least clean area (elbows) to prevent contaminated water from
flowing over clean areas. Water flowing from elbows to hands would carry contaminants from
the less clean elbow area to the cleaner hands, violating aseptic technique.
Question 5
A bariatric patient with a BMI of 52 is scheduled for a laparoscopic Roux-en-Y gastric bypass. The
surgical technologist is preparing the OR and coordinating with the circulating nurse. Which of
the following equipment and positioning considerations is MOST critical for this patient's
safety?
A) Standard OR table with extra padding, standard-length instruments, and supine
positioning without arm boards.
CERTIFIED SURGICAL TECHNOLOGIST
Advanced-Level Practice Examination | 150
Questions | Detailed Rationales
TABLE OF CONTENTS
Section Title Questions
I Perioperative Care – Preoperative Preparation 1–25
II Perioperative Care – Intraoperative Procedures 26–75
III Perioperative Care – Postoperative Procedures 76–85
IV Ancillary Duties – Administrative & Personnel 86–95
V Ancillary Duties – Equipment Sterilization & Maintenance 96–110
VI Basic Science – Anatomy & Physiology 111–130
VII Basic Science – Microbiology & Infection Control 131–140
VIII Basic Science – Surgical Pharmacology & Anesthesia 141–150
SECTION I: PERIOPERATIVE CARE – PREOPERATIVE PREPARATION (Questions 1–25)
, Question 1
A 74-year-old patient with a history of chronic obstructive pulmonary disease (COPD), type 2
diabetes mellitus, and a 45-pack-year smoking history is scheduled for an open abdominal aortic
aneurysm repair. The surgical technologist is reviewing the surgeon's preference card and
preoperative orders. Which of the following combinations of interventions represents the MOST
comprehensive strategy to minimize this patient's risk of postoperative pulmonary
complications and surgical site infections?
A) Administer preoperative prophylactic vancomycin 2 hours prior to incision, maintain strict
NPO status for 12 hours, and position the patient in the Trendelenburg position during transport
to the OR.
B) Coordinate with the anesthesia provider for bronchodilator therapy, ensure appropriate
glycemic control with insulin sliding scale, encourage incentive spirometry education, and verify
that the preoperative antibiotic (cefazolin) is administered within 60 minutes of incision.
C) Restrict all oral fluids for 24 hours preoperatively, administer preoperative sedatives to
reduce anxiety, and apply sequential compression devices (SCDs) only after the patient is
anesthetized.
D) Shave the surgical site the night before surgery using a straight razor, administer broad-
spectrum antibiotics 4 hours prior to incision, and position the patient in the prone position for
the procedure.
CorreCt answer : B
Rationale: This patient has multiple risk factors for postoperative complications. COPD and
smoking history increase pulmonary risk, while diabetes increases infection risk. Optimal
management includes bronchodilator therapy for pulmonary optimization, glycemic control to
reduce infection risk, incentive spirometry education, and proper timing of prophylactic
antibiotics (within 60 minutes of incision). NPO for 24 hours is excessive and dangerous;
Trendelenburg positioning would impair respiration; shaving the night before increases infection
risk; and prone positioning is inappropriate for this procedure.
Question 2
The surgical technologist is preparing the operating room for a complex pediatric craniofacial
reconstruction. The patient is a 6-month-old infant with a documented allergy to latex and a
history of malignant hyperthermia in a sibling. Which of the following represents the MOST
comprehensive preoperative preparation strategy?
, A) Prepare the OR with standard equipment, keep a latex-free cart available outside the
room, and have dantrolene sodium readily accessible.
B) Ensure all latex-containing products are removed from the OR and implement a latex-safe
protocol, prepare the anesthesia machine by removing volatile anesthetic agents and have
dantrolene sodium immediately available, verify appropriate pediatric-sized equipment and
positioning devices, and participate in a thorough Time Out.
C) Use only powder-free latex gloves, maintain the OR temperature at 65°F, and have
succinylcholine available for malignant hyperthermia treatment.
D) Apply a sterile latex glove over a non-latex glove for double-gloving, use adult-sized
positioning devices with extra padding, and administer preoperative diphenhydramine for latex
allergy prophylaxis.
CorreCt answer : B
Rationale: This scenario involves multiple critical safety considerations. Latex allergy requires
complete removal of all latex-containing products from the OR. Malignant hyperthermia
susceptibility requires removal of triggering agents (volatile anesthetics and succinylcholine)
and immediate availability of dantrolene sodium. Pediatric patients require appropriately sized
equipment and positioning devices. The Time Out is essential for patient safety. Powdered
gloves are contraindicated in latex allergy. Double-gloving with latex still exposes the patient.
Adult-sized equipment is unsafe for a 6-month-old infant.
Question 3
During the preoperative verification process, the surgical technologist is participating in the
Universal Protocol Time Out. The circulating nurse reads the patient's name and date of birth,
the surgeon confirms the procedure, and the site is marked. However, the surgical technologist
notices that the consent form indicates a right-sided procedure, but the patient's imaging
reports and the surgical site marking indicate a left-sided procedure. What is the MOST
appropriate action?
A) Proceed with the procedure as the surgeon has confirmed the site marking.
B) Silently note the discrepancy and document it after the procedure.
C) Immediately speak up and halt the Time Out process, clearly stating the discrepancy
between the consent form, imaging, and site marking, and request clarification before
proceeding.
D) Inform the circulator privately after the Time Out is completed.
CorreCt answer : C
, Rationale: A discrepancy between the consent form, imaging, and surgical site marking
represents a critical safety issue that could lead to a wrong-site surgery. The surgical
technologist has a professional and ethical obligation to speak up immediately and halt the
process until the discrepancy is resolved. Patient safety supersedes concerns about hierarchy or
embarrassment. Proceeding with the procedure, ignoring the discrepancy, or addressing it after
the Time Out would be unsafe and unprofessional.
Question 4
The surgical technologist is performing the initial surgical hand scrub of the day using the
traditional brush method. Which of the following sequences represents the CORRECT
anatomical progression for the scrub technique?
A) Scrub the hands first, then the forearms, then the elbows, allowing water to run from the
elbows toward the hands.
B) Scrub the hands first, then the forearms, then the elbows, allowing water to run from the
hands toward the elbows.
C) Scrub the forearms first, then the hands, then the elbows, allowing water to run from the
elbows toward the hands.
D) Scrub the nails first, then the hands, then the forearms, then the elbows, allowing water
to run from the hands toward the elbows.
CorreCt answer : D
Rationale: The correct surgical scrub technique involves scrubbing the nails first (using a nail
cleaner), then the hands, then the forearms, and finally the elbows. Water must flow from the
cleanest area (hands) toward the least clean area (elbows) to prevent contaminated water from
flowing over clean areas. Water flowing from elbows to hands would carry contaminants from
the less clean elbow area to the cleaner hands, violating aseptic technique.
Question 5
A bariatric patient with a BMI of 52 is scheduled for a laparoscopic Roux-en-Y gastric bypass. The
surgical technologist is preparing the OR and coordinating with the circulating nurse. Which of
the following equipment and positioning considerations is MOST critical for this patient's
safety?
A) Standard OR table with extra padding, standard-length instruments, and supine
positioning without arm boards.
