NBSTSA CSFA Exam Questions

Correct answer: Incising the skin over the medial aspect of the leg

The crucial initial step in harvesting the saphenous vein during a Coronary Artery Bypass Graft (CABG) procedure is incising the skin over the medial aspect of the leg. This step provides the necessary access to the vein for the surgeon to perform the grafting process efficiently.

Clamping the femoral artery is not related to saphenous vein harvesting. A tourniquet is unnecessary and could restrict blood flow improperly, potentially leading to tissue necrosis. Injecting heparin is a later step done to prevent clotting and is not part of the initial harvesting procedure.

Correct answer: Apply direct pressure with a sterile gauze pad

Applying direct pressure with a sterile gauze pad is the most immediate action to control the bleeding as it temporarily stops the blood flow, allowing the surgeon time to plan a more definitive method of hemostasis.

Using a suture to ligate the vessel is a definitive solution but not the immediate first step. Applying a tourniquet above the bleeding site is not typically used in controlled surgical settings and can cause ischemia. Using an electrocautery device is effective but may not be the immediate first step when compared to direct pressure.

Correct answer: Ensuring the suture is placed at equal distances to distribute tension evenly

When closing the fascia, it is crucial to ensure sutures are placed at equal distances to distribute tension evenly. This practice reduces the risk of tissue ischemia and promotes effective wound healing by ensuring consistent support along the wound.

Using the smallest possible suture material might reduce tissue reaction but may lack the necessary strength for fascia closure, increasing the risk of wound dehiscence. Placing sutures only at the corners of the wound is insufficient for securing the fascia and fails to distribute tension evenly. Applying high tension to each suture can cause tissue damage and ischemia, leading to poor healing outcomes.

Correct answer: Ensuring the camera is securely connected to the light source and monitor

Ensuring the camera is securely connected to the light source and monitor is the most important step before using an endoscopic camera. This step guarantees that the camera will transmit clear and reliable images, which are essential for the surgeon to perform the procedure accurately and effectively.

Checking the expiration date of the camera is generally not applicable, as endoscopic cameras typically do not have an expiration date affecting their use. Pre-warming the camera to body temperature is unnecessary and does not influence its performance. While disinfecting the camera is critical for maintaining sterility, it does not ensure the operational functionality of the camera.

Correct answer: Insufficient anesthesia

The most likely cause of tachycardia and elevated blood pressure during surgery is insufficient anesthesia. Inadequate anesthetic depth can result in a stress response to surgical stimuli, leading to increased sympathetic nervous system activity, tachycardia, and hypertension. Addressing these signs requires adjusting the anesthetic plan to ensure adequate pain control and patient comfort.

Hemorrhage typically results in hypotension due to blood loss, not hypertension.

Stable hemodynamic status involves normal vital signs, not the elevated heart rate and blood pressure seen in this scenario.

Decreased cardiac output is associated with hypotension and reduced perfusion rather than hypertension and tachycardia.

Correct answer: Ensure the backup power system is functioning

The first step in the event of a sudden power outage during surgery should be to ensure the backup power system is functioning. This action is vital to restore power to critical equipment and maintain the continuity of the surgical procedure, thereby ensuring patient safety and avoiding potential complications from the power loss.

Stopping the surgery and covering the patient would not address the core issue of restoring power. Ensuring non-electric equipment is present is a preventive measure but does not resolve the immediate need for power restoration. Turning off all surgical equipment to prevent damage would be secondary to ensuring that the equipment is operational again through the backup power system.

Correct answer: Calmly suggest taking a moment to regroup

Calmly suggesting taking a moment to regroup is the most effective approach to de-escalate a high-stress situation during surgery. This strategy allows the team to momentarily pause, collect their thoughts, and return to the task with a clearer mindset. It promotes a supportive and professional environment which is crucial for maintaining team dynamics and ensuring patient safety.

Responding with a louder voice to assert authority only intensifies the conflict and creates a hostile atmosphere, which can be detrimental to both team morale and the surgical outcome. Ignoring the behavior allows the issue to fester and potentially disrupt the procedure further. Reporting the behavior after the surgery does not provide an immediate solution and can lead to resentment, further harming team cohesion.

Correct answer: Epinephrine

Epinephrine is the first and most critical medication to administer in an anaphylactic reaction due to its rapid action and ability to address the most severe symptoms of anaphylaxis. It acts as a vasoconstrictor, reducing the widespread vasodilation and hypotension seen in anaphylaxis, and also as a bronchodilator, alleviating bronchospasm and improving airway patency. Additionally, epinephrine increases cardiac output, helping to stabilize hemodynamic status during the acute phase of anaphylaxis.

Diphenhydramine, an antihistamine, is helpful for relieving some allergic symptoms but is not sufficient to address the severe systemic effects of anaphylaxis on its own.

Hydrocortisone, a corticosteroid, has a delayed onset and is used more for preventing prolonged or recurrent symptoms rather than immediate treatment.

Albuterol is effective in addressing bronchospasm but does not counteract the systemic effects of anaphylaxis such as hypotension and shock.

Correct answer: Ensuring equal spacing to promote uniform healing

Ensuring equal spacing is critical when closing the skin with staples to promote uniform healing and minimize the risk of complications such as scarring or improper wound healing.

The magnetic properties of staples are generally not a consideration in skin closure, as standard staples are typically used. Applying maximum tension to staples can damage the tissue and impede proper healing, making it an incorrect approach. Absorbable staples are not commonly used in skin closure; the more critical consideration is proper spacing, not the material.

Correct answer: Liposarcoma

Liposarcoma is a malignant tumor that originates from adipose tissue and is characterized by the proliferation of abnormal fat cells. Due to its potential for local recurrence and metastasis, liposarcoma requires precise surgical excision to ensure complete removal of the tumor and reduce the risk of recurrence.

Osteosarcoma arises from bone tissue and typically occurs in the long bones, necessitating surgical interventions specific to bone tumors.

Chondrosarcoma originates from cartilage cells and is treated based on its location in cartilaginous structures.

Rhabdomyosarcoma develops from skeletal muscle tissue and involves treatment strategies focused on muscle tumors rather than adipose tissue.

Correct answer: To prevent fluid overload

Monitoring the amount of irrigation solution used during surgery is crucial primarily to prevent fluid overload. This condition can cause severe complications, including pulmonary edema and heart failure. Ensuring that the patient's fluid balance remains within safe limits, their overall health and well-being are prioritized.

Minimizing the cost of supplies, although beneficial, is secondary to patient safety considerations. Keeping the surgical field dry is important for visibility and effectiveness but does not outweigh the need to prevent fluid overload. Reducing the risk of infection is managed through sterile techniques and appropriate antibiotic use, not by the volume of irrigation solution monitored.

Correct answer: Electrocautery

Electrocautery is often used to achieve hemostasis of the cystic artery because it provides effective coagulation and minimizes bleeding. This tool allows the surgeon to quickly and efficiently control bleeding during the procedure.

A hemostatic clamp can control bleeding temporarily but does not achieve definitive hemostasis.

Suture ligature is effective but is typically used after electrocautery to ensure hemostasis.

Gel foam is used to control bleeding in areas where mechanical methods are less effective and is not typically used for the cystic artery.

Correct answer: Discreetly inform the team member of the oversight and suggest corrective action

Discreetly informing the team member of the oversight and suggesting corrective action is the best way to handle a critical missed step during surgery. This method maintains professionalism and respect, allowing the issue to be addressed promptly without causing embarrassment or tension. It ensures that patient safety is upheld while fostering a collaborative and supportive team environment.

Reprimanding the team member publicly can create a hostile and negative atmosphere, undermining morale and increasing the likelihood of further mistakes.

Correcting the mistake yourself without addressing it immediately misses an opportunity for the team member to learn and take responsibility, potentially leading to repeated errors.

Reporting the mistake to a supervisor right away bypasses the chance for immediate correction and learning, creating an environment of distrust and punishment rather than support and improvement. Addressing the issue directly and discreetly is crucial for maintaining positive team dynamics and ensuring patient safety.

Correct answer: Spinal cord

The spinal cord is the structure most likely compromised if a patient develops paraplegia following surgery to repair an abdominal aortic aneurysm. The spinal cord is crucial for transmitting motor and sensory signals between the brain and the lower body. Damage to the spinal cord during such a surgical procedure can result in paraplegia, characterized by the loss of motor and sensory functions in the lower extremities.

The iliac artery, while important for blood supply to the lower limbs, would not directly cause paraplegia if damaged; it would instead lead to ischemia and possibly necrosis of the tissues it supplies.

The renal artery, responsible for blood flow to the kidneys, does not affect motor or sensory functions in the lower body, so its injury would not result in paraplegia.

Injury to the inferior vena cava would result in severe circulatory issues, but not in the loss of motor and sensory function leading to paraplegia.

Correct answer: Adjusting the surgical mask with sterile gloves

Adjusting the surgical mask with sterile gloves is a breach of aseptic protocol because it introduces contamination from the mask to the sterile gloves. The outside of the mask is not sterile and can harbor pathogens from the environment. By touching the mask, the sterile gloves become contaminated, posing a risk of transferring pathogens to the sterile field or surgical site.

Using the gown sleeves to apply gloves helps maintain glove sterility by avoiding contact with potentially contaminated surfaces.

Keeping hands above the waist level is a standard practice to prevent glove contamination from lower surfaces.

Touching sterile drapes with sterile gloves is part of setting up the sterile field and is consistent with aseptic practices.

Correct answer: Using sterile technique and maintaining asepsis throughout the procedure.

The essential technique to minimize the risk of infection during the insertion of a Foley catheter is using sterile technique and maintaining asepsis throughout the procedure. This comprehensive approach ensures that no pathogens are introduced during the catheterization, significantly reducing the risk of infection.

Inserting the catheter with a sterile lubricant is necessary but does not encompass the entire scope of aseptic technique. Positioning the drainage bag below the level of the bladder is crucial for proper drainage but does not directly impact infection control. Maintaining asepsis only until the catheter is ready for insertion is inadequate, as asepsis must be upheld throughout the entire process to effectively prevent infection.

Correct answer: Low hemoglobin

Low hemoglobin is a key laboratory result indicating the need for a blood transfusion in a pediatric surgical patient experiencing significant intraoperative blood loss. Hemoglobin is the primary protein in red blood cells responsible for oxygen transport, and low levels suggest anemia, which can lead to tissue hypoxia and impaired organ function. Transfusing blood increases hemoglobin levels, restoring the patient's oxygen-carrying capacity and ensuring that tissues receive adequate oxygenation during and after surgery.

Low serum potassium can require electrolyte replacement to correct hypokalemia but does not address blood loss or anemia.

High Blood Urea Nitrogen (BUN) can result from renal impairment or dehydration, necessitating interventions to improve kidney function and fluid status rather than transfusion.

Elevated blood glucose requires management with insulin or dietary changes to control hyperglycemia, unrelated to anemia or blood volume restoration.

Correct answer: Meshing the graft

Meshing the graft is the technique used to increase the surface area of the graft by creating small incisions, allowing it to expand and cover larger wound areas. This method also enhances the graft's conformity to the wound site, promoting better healing.

Stretching the graft manually can damage the tissue and does not provide a controlled increase in surface area. Layering grafts increases thickness rather than surface area. Culturing is a method for growing cells and does not mechanically expand a skin graft.

Correct answer: Label the specimen container before passing it off the sterile field

The best practice for a surgical first assistant when handling a specimen for pathological examination during surgery is to label the specimen container before passing it off the sterile field. This practice ensures the specimen is accurately identified and reduces the risk of mislabeling, which is critical for proper diagnosis and treatment.

Passing the specimen off the field for the surgical technologist to label increases the risk of miscommunication and potential labeling errors. Leaving the specimen on the sterile field until the surgeon labels it or until the end of the procedure delays proper handling and processing, increasing the risk of contamination or loss of the specimen.

Correct answer: They block sodium channels to prevent depolarization of nerve cells.

Local anesthetics are drugs that work by blocking voltage-gated sodium channels in the membranes of nerve cells. This blockade prevents sodium ions from entering the nerve cells, which is a crucial step in the generation and propagation of action potentials. By stopping this influx of sodium ions, local anesthetics effectively prevent nerve cells from depolarizing, thereby halting the transmission of nerve impulses. This results in a loss of sensation in the targeted area, allowing for pain relief without affecting consciousness.

Inhibiting the release of neurotransmitters in the central nervous system is not how local anesthetics function; they act peripherally on nerves rather than centrally on neurotransmitter systems.

Enhancing inhibitory neurotransmitter action is not the primary mechanism of local anesthetics, as their effect is based on sodium channel blockade.

The blockade of sodium channels increases the threshold for action potential initiation; it does not decrease it.