CNOR CNOR - Certification Wound Management and Tissue Handling 2 — Questions and Answers
Question 1: Which factor most significantly increases a patient's risk of surgical site infection (SSI)?
- Using a reusable gown instead of disposable
- Uncontrolled diabetes mellitus with elevated blood glucose (Correct answer)
- The use of self-retaining retractors
- Operating room temperature above 68°F
Correct answer: Uncontrolled diabetes mellitus with elevated blood glucose
Hyperglycemia impairs neutrophil function and tissue perfusion, significantly increasing susceptibility to SSI.
Question 2: The scrub person should handle tissue on the sterile field by:
- Squeezing tissue firmly with toothed forceps to prevent slipping
- Using the least traumatic technique, handling tissue as gently as possible (Correct answer)
- Avoiding moistening tissue with saline to keep the field dry
- Applying maximum tension to expose the operative site
Correct answer: Using the least traumatic technique, handling tissue as gently as possible
Gentle tissue handling minimizes trauma, preserves viability, and reduces the risk of postoperative complications including infection and dehiscence.
Question 3: When is prophylactic antibiotic administration most effective for SSI prevention?
- 48 hours before surgery
- Within 60 minutes before skin incision (or within 120 minutes for vancomycin) (Correct answer)
- Immediately after wound closure
- Only if the case lasts longer than 2 hours
Correct answer: Within 60 minutes before skin incision (or within 120 minutes for vancomycin)
Administering prophylactic antibiotics within 60 minutes before incision (120 minutes for vancomycin/fluoroquinolones) ensures adequate tissue levels at the time of potential contamination.
Question 4: Primary intention wound healing occurs when:
- A wound is left open to granulate from the inside out
- Wound edges are approximated and secured with sutures, staples, or tissue adhesive (Correct answer)
- A skin graft is applied over a large defect
- Healing occurs without any intervention
Correct answer: Wound edges are approximated and secured with sutures, staples, or tissue adhesive
Primary intention (primary closure) involves directly approximating clean wound edges, resulting in minimal scarring and faster healing.
Question 5: Wound dehiscence is defined as:
- Separation of previously approximated wound layers (Correct answer)
- Infection of a wound with purulent drainage
- Prolapse of abdominal organs through a wound opening
- Formation of excess scar tissue beyond the wound margin
Correct answer: Separation of previously approximated wound layers
Dehiscence is the partial or complete separation of the layers of a surgical wound that were previously closed.
Question 6: Evisceration differs from dehiscence in that evisceration involves:
- Only the skin layer separating
- Protrusion of abdominal organs through the open wound (Correct answer)
- Chronic wound infection without separation
- Keloid formation at the incision site
Correct answer: Protrusion of abdominal organs through the open wound
Evisceration is a serious complication in which internal organs (typically intestines) protrude through a dehisced abdominal wound.
CNOR CNOR - Certification Wound Management and Tissue Handling 2
Which factor most significantly increases a patient's risk of surgical site infection (SSI)?