AAVSB - American Association of Veterinary State Boards Surgical Procedures and Nursing Questions and Answers — Questions and Answers
Question 1: A circulating nurse in the operating room observes a sterile-gowned surgeon lean against a non-sterile wall. Which of the following is the most appropriate immediate action for the nurse to take?
- Continue with the procedure as the front of the gown is likely still sterile.
- Announce the break in sterile technique and assist the surgeon in changing their gown and gloves. (Correct answer)
- Place a sterile drape over the contaminated area of the surgeon's back.
- Immediately apply a disinfectant solution to the area of the gown that touched the wall.
Correct answer: Announce the break in sterile technique and assist the surgeon in changing their gown and gloves.
Aseptic technique dictates that once a sterile item or person contacts a non-sterile surface, it is considered contaminated. The only correct action is to address the break in sterility immediately by having the surgeon regown and reglove to prevent potential surgical site infection. Ignoring the break, attempting to cover it, or trying to disinfect it are all violations of sterile principles.
Question 2: What are the standard minimum time, temperature, and pressure settings for sterilizing a routine surgical instrument pack in a gravity displacement autoclave?
- 10 minutes at 115°C (240°F) and 10 psi
- 3 minutes at 132°C (270°F) and 30 psi
- 15 minutes at 121°C (250°F) and 15 psi (Correct answer)
- 20 minutes at 100°C (212°F) and 5 psi
Correct answer: 15 minutes at 121°C (250°F) and 15 psi
The generally accepted standard for routine sterilization of surgical packs in a gravity displacement steam sterilizer is an exposure time of 13-15 minutes at a temperature of 121°C (250°F) and a pressure of 15 psi. The 3-minute cycle at 132°C is typically used for flash sterilization of unwrapped instruments, not routine packs.
Question 3: During anesthesia, the capnograph for a 6-year-old canine patient shows an end-tidal CO2 (ETCO2) reading consistently between 55-60 mmHg. The waveform is normal in shape, but the baseline is not returning to zero. Which of the following is the most likely cause?
- Hyperventilation due to a light plane of anesthesia.
- Malfunctioning one-way valve or exhausted CO2 absorbent. (Correct answer)
- Hypotension caused by the anesthetic agent.
- Esophageal intubation.
Correct answer: Malfunctioning one-way valve or exhausted CO2 absorbent.
When the capnograph baseline does not return to zero, it indicates the patient is rebreathing carbon dioxide. Common causes for this in a rebreathing circuit include exhausted or saturated soda lime (CO2 absorbent) or a malfunctioning one-way (inspiratory or expiratory) valve. Hyperventilation would cause a low ETCO2, while esophageal intubation would result in a near-zero reading.
Question 4: A 9-month-old cat is in recovery following an ovariohysterectomy. The veterinary nurse notes the cat is shivering intensely, has a rectal temperature of 36.1°C (97.0°F), and is slow to respond. Which of the following is a significant potential complication of this patient's condition?
- Rebound hyperthermia
- Rapid anesthetic metabolism
- Prolonged recovery and delayed drug metabolism (Correct answer)
- Hypertension and tachycardia
Correct answer: Prolonged recovery and delayed drug metabolism
The cat is exhibiting signs of significant perioperative hypothermia. Hypothermia impairs hepatic metabolism, which can delay the clearance of anesthetic drugs, leading to a prolonged and slow recovery. It can also cause bradycardia and hypotension, not hypertension and tachycardia. While rebound hyperthermia can occur, the immediate and primary concern is the delayed metabolism and prolonged recovery.
Question 5: When selecting a suture material for closing the linea alba in a large, active dog, which characteristic is LEAST desirable?
- High tensile strength
- Monofilament structure
- Absorbable with a rapid loss of strength (Correct answer)
- Good knot security
Correct answer: Absorbable with a rapid loss of strength
The linea alba is a slow-healing fascial layer that requires prolonged support. A suture material that is absorbable but loses its tensile strength rapidly (e.g., within 2-3 weeks) would be inappropriate, as it could lead to incisional herniation. A suture with high tensile strength, a monofilament structure (to reduce bacterial wicking), and good knot security are all desirable qualities for this type of closure.
Question 6: A veterinary technician is preparing a patient's skin for orthopedic surgery. Which of the following represents the correct final step in the aseptic skin preparation process?
- A final paint of antiseptic solution, applied starting at the periphery and working towards the center of the proposed incision site.
- Wiping the prepared area with a dry, sterile gauze sponge to remove excess solution.
- A final paint of antiseptic solution, applied starting at the center of the proposed incision site and working outwards in a circular pattern. (Correct answer)
- Rinsing the area thoroughly with sterile saline after the final antiseptic scrub.
Correct answer: A final paint of antiseptic solution, applied starting at the center of the proposed incision site and working outwards in a circular pattern.
The final step of aseptic skin preparation involves applying a final 'paint' of antiseptic solution. This should be done starting at the location of the planned incision and moving outward in an ever-expanding circular or linear pattern. This technique prevents dragging contaminants from the unprepared periphery back over the clean central area. One should never move from the periphery to the center during this process.
AAVSB - American Association of Veterinary State Boards Surgical Procedures and Nursing Questions and Answers
A circulating nurse in the operating room observes a sterile-gowned surgeon lean against a non-sterile wall.
Which of the following is the most appropriate immediate action for the nurse to take?