NBSTSA CSFA Exam Questions

Correct answer: Discuss the comment privately with the team member and explain why it was inappropriate

Handling culturally insensitive comments requires a balance of discretion and education. Discussing the comment privately with the team member allows for a respectful dialogue where the specific issues can be addressed without causing undue embarrassment.

Addressing the comment only if someone present might be upset fails to acknowledge the broader importance of cultural respect. Publicly confronting the team member can result in defensiveness and disrupt team dynamics, undermining the intended educational purpose. Reporting the comment to administration as a first step can be seen as punitive and bypasses the opportunity for direct, personal growth and learning.

Correct answer: Supine position

The most appropriate position for a patient undergoing abdominal surgery to ensure optimal access to the surgical site is the supine position. This position allows the surgeon the best access to the abdominal cavity and is commonly used for a variety of abdominal procedures.

The Trendelenburg position is more suited for lower abdominal and pelvic surgeries, not general abdominal procedures. The lithotomy position is used for gynecological, urological, and colorectal surgeries and is not ideal for general abdominal access. The lateral position is used for surgeries involving the side of the body and does not provide optimal access to the abdominal area.

Correct answer: To prevent skin irritation and provide comfort

The primary purpose of using a stockinette during the casting procedure is to prevent skin irritation and provide comfort. The stockinette acts as a soft, protective layer between the patient's skin and the cast material, reducing friction and potential irritation, thus enhancing the overall comfort of the patient during the casting process.

The stockinette does not contribute to the strength or rigidity of the cast; these properties are determined by the casting materials used.

It also does not play a role in promoting faster drying of the cast.

Proper limb alignment during casting is maintained through the accurate application of the cast material itself, not by the stockinette. The stockinette’s primary role is to provide a protective barrier to prevent skin irritation.

Correct answer: Stirrups with adjustable supports

Stirrups with adjustable supports are essential for safely positioning a patient in the lithotomy position as they provide crucial leg support and allow for necessary adjustments to ensure patient comfort and stability. The proper use of stirrups helps prevent nerve damage and other complications by maintaining correct leg alignment throughout the procedure.

Foam padding for the head, while important for overall comfort, does not address the specific needs of the lithotomy position. Knee supports and sandbags might offer some assistance but are not sufficient on their own to ensure safe and stable positioning. Only stirrups with adjustable supports can provide the comprehensive leg support required for this position.

Correct answer: Absorbable synthetic suture

Absorbable synthetic sutures are preferred for closing the subcutaneous layer because they are designed to be absorbed by the body, minimizing the risk of foreign body reaction and eliminating the need for suture removal. This promotes a more comfortable healing process for the patient.

Non-absorbable silk sutures can cause significant tissue reactions and require removal after healing, making them less ideal. Stainless steel wire is very rigid and would increase the potential for discomfort and foreign body reaction. Non-absorbable nylon sutures also necessitate removal and can cause tissue reactions, making them less ideal for subcutaneous closure.

Correct answer: Contaminated

A contaminated wound classification is appropriate for the surgical repair of a perforated duodenal ulcer with spillage of gastrointestinal contents due to the nature of the exposure to potentially infectious material. When a duodenal ulcer perforates, gastric and duodenal contents containing bacteria and digestive enzymes spill into the peritoneal cavity. This creates an environment with a high risk of bacterial contamination, which meets the criteria for a contaminated wound.

Clean wounds are those with no entry into the gastrointestinal tract or sterile environments where infection risk is minimal.

Clean-contaminated wounds involve controlled surgical entry into the gastrointestinal tract without spillage, which does not fit this scenario.

Dirty or infected classifications are typically reserved for wounds with infections or necrotic tissues, which are not indicated as being present in this scenario.

Correct answer: Comminuted fracture

A comminuted fracture is defined by the bone breaking into several pieces, often as a result of high-impact trauma. This type of fracture presents a complex situation for treatment, requiring careful alignment and stabilization of the multiple bone fragments to ensure proper healing.

Greenstick fractures involve the bending and cracking of the bone without completely breaking it into separate pieces.

Spiral fractures occur due to a twisting force causing a helical break, not fragmenting the bone.

Transverse fractures involve a straight break across the bone, differing significantly from the shattering seen in comminuted fractures.

Correct answer: McBurney’s point

McBurney’s point is the crucial anatomical landmark in acute appendicitis surgery as it helps the surgeon locate the appendix accurately. It is located one-third the distance from the anterior superior iliac spine to the umbilicus, directly over the appendix base.

The linea alba, while important in abdominal surgeries for other reasons, does not assist in locating the appendix. Similarly, the inguinal ligament is relevant in hernia surgeries but not in appendicitis, and the costal margin is part of the rib cage, unrelated to the appendix’s position.

Correct answer: Wrapping the graft in moist, sterile gauze

Wrapping the bone graft in moist, sterile gauze is critical to ensure it remains viable and suitable for transplantation. This step is essential to prevent the graft from drying out, thereby preserving the living cells and proteins that are crucial for successful integration into the recipient site.

While an antibiotic solution can reduce infection risk, it does not necessarily provide the necessary moisture for cell survival. Autoclaving destroys essential biological components and renders the graft non-viable. Freezing, although useful for long-term storage, can compromise cellular integrity and is not appropriate for grafts intended for immediate use.

Correct answer: Ensuring all wheels on the stretcher are locked

Ensuring all wheels on the stretcher are locked is an important safety measure when transferring a patient from the operating table to the stretcher post-operatively. Locking the wheels prevents the stretcher from moving unexpectedly, which significantly reduces the risk of falls and injuries during the transfer process.

Transferring the patient quickly increases the likelihood of errors and accidents, making it an unsafe approach. Removing all intravenous lines before the transfer can compromise patient care by disrupting necessary treatments and is not necessary. While having an adequate number of team members to assist with the transfer is important, using at least six team members is generally excessive.

Correct answer: Ureter

In the context of kidney stone removal surgery, the ureter is the most commonly involved part of the urinary system. Kidney stones often migrate from the kidney into the ureter, where they can cause significant pain and obstruction. The ureter's role in transporting urine from the kidney to the bladder makes it the primary site of interest during such surgical procedures, as stones frequently become lodged here, necessitating direct surgical intervention to remove them and restore normal urine flow.

The urethra, which channels urine from the bladder out of the body, is not usually involved in the removal of kidney stones unless the stones have progressed through the urinary system. As the urethra has a wider diameter than the ureters, it is much less likely to be involved.

The bladder's function as a urine reservoir means it is not typically the site of stone formation or surgical removal.

The renal cortex, the part of the kidney where initial filtration occurs, is implicated in stone formation but not directly targeted during stone removal surgeries, as the focus is on the passage of stones through the ureter where they typically become obstructed and cause symptoms.

Correct answer: Wilson frame

The Wilson frame is the most important positioning device for maintaining proper alignment and safety during spinal surgery performed in the prone position. This device is specifically designed to support the body and ensure correct spinal alignment, which is crucial for the success of the surgery and the patient’s safety.

A bean bag positioner, while useful for general support, does not offer the precision needed for spinal alignment. Knee crutches are intended to support the legs, not the spine, and therefore do not provide the necessary alignment. Arm boards are used to secure the arms during surgery but do not address the alignment of the spine, making them inadequate for this purpose.

Correct answer: Laparotomy sponge

When controlling bleeding during an exploratory laparotomy, the most appropriate tool is the laparotomy sponge. These sponges are specifically designed for open abdominal surgeries, offering high absorbency and ease of use. They also typically have radiopaque markers, which help ensure they are not accidentally left inside the patient.

Raytec sponges are smaller and less absorbent, making them more appropriate for minor procedures. Neurological sponges are designed for neurosurgical use and are not effective in packing large surgical sites. Dental rolls are intended for dental use and lack the necessary size and absorbency for controlling bleeding in abdominal surgeries.

Correct answer: 2.5 mL

To administer the correct dose of 250 mg from a solution with a concentration of 100 mg/mL, we divide the total desired dose by the concentration. This yields the required volume, 2.5 mL, which ensures the correct amount of medication is delivered.

Other answers result from incorrect mathematical applications or misunderstandings of the relationship between dose and concentration.

Correct answer: Heparinized saline

Heparinized saline is most commonly used to temporarily store the radial artery graft because it effectively prevents clot formation and maintains the vessel's patency. This anticoagulant solution is essential for preserving the graft's functionality and ensuring it remains viable for coronary bypass surgery.

Normal saline, lactated Ringer's solution, and dextrose 5% in water are not suitable for storing the radial artery graft, as all of these storage methods lack anticoagulant properties and do not prevent clot formation.

Correct answer: Clean the spill with a detergent solution, followed by a hospital-approved disinfectant.

The recommended procedure for cleaning up a blood spill during surgery is to first clean the spill with a detergent solution, followed by a hospital-approved disinfectant. This method ensures that any organic material, such as blood or bodily fluids, is removed before applying a disinfectant. The detergent acts as a cleaning agent to break down and remove organic debris, while the disinfectant kills any remaining pathogens. This two-step process is crucial for effective infection control, ensuring that the area is thoroughly cleaned and disinfected to prevent the spread of infectious agents and maintain a safe surgical environment.

Wiping with a dry cloth can spread contaminants and does not remove or kill pathogens.

Covering the spill with sterile towels delays necessary cleaning and can increase the risk of spreading infection.

Using alcohol alone is insufficient for disinfecting all types of pathogens, as it does not effectively remove organic material.

Correct answer: Succinylcholine

Succinylcholine is the drug of choice for rapid-onset muscle relaxation due to its quick action as a depolarizing neuromuscular blocker. It provides muscle paralysis within 30 to 60 seconds. This makes it ideal for rapid intubation and situations where immediate muscle relaxation is required, such as in emergencies or short surgical procedures. Succinylcholine’s rapid onset and short duration of action make it suitable for procedures requiring quick and reversible muscle relaxation.

Other muscle relaxants like rocuronium, pancuronium, and vecuronium have slower onsets of action compared to succinylcholine. Rocuronium offers a relatively fast onset but does not match the speed of succinylcholine, making it less ideal for immediate needs.

Pancuronium and vecuronium are non-depolarizing neuromuscular blockers with slower onsets and longer durations, suitable for maintaining paralysis during prolonged surgeries but not for rapid induction.

Correct answer: Ureter

The ureter is the structure most at risk for damage during a prostatectomy due to its close anatomical relationship with the prostate. This proximity makes it susceptible to inadvertent injury, which can result in serious complications such as urinary leakage or ureteral strictures, affecting the patient's postoperative recovery and urinary function.

While the seminal vesicles are located near the prostate, they are typically well-visualized during surgery, making them less prone to accidental damage.

The epididymis is part of the male reproductive system but is situated away from the prostate, thus not at risk during this type of surgery.

The vas deferens, although potentially encountered, is less critical than the ureters, as its damage does not carry the same level of risk for significant postoperative complications.

Correct answer: Reduced risk of injury to adjacent structures

A key advantage of using bipolar cautery over monopolar cautery in neurosurgical procedures is the reduced risk of injury to adjacent structures because the electrical current is confined between the tips of the forceps. This containment minimizes collateral damage to delicate neural tissues.

Bipolar cautery is not primarily used for cutting but for coagulation, so cutting efficiency is not a key advantage. Lower thermal output is not as significant an advantage as the reduced risk of injury to surrounding tissues. Lower power requirement is a feature but not the primary advantage in the context of neurosurgical procedures.

Correct answer: Inform the surgical team and prepare to evacuate the patient if necessary

In the event of a bomb threat during a surgical procedure, it is crucial to inform the surgical team and prepare to evacuate the patient if necessary. This step ensures that everyone is aware of the potential threat and can act quickly to move to safety, prioritizing the lives and well-being of the patient and medical staff.

Continuing the surgery and avoiding electronic equipment does not address the immediate threat and could put everyone at greater risk.

Contacting the bomb squad is essential but should follow the immediate steps to prepare for evacuation.

Locking the operating room doors can be dangerous as it may trap individuals inside, worsening the situation if evacuation becomes necessary.