NBSTSA Wound Management & Surgical Complications 4 — Questions and Answers
Question 1: Which type of drain works by creating negative pressure to actively remove fluid from a wound cavity?
- Penrose drain
- Jackson-Pratt drain (Correct answer)
- T-tube drain
- Malecot drain
Correct answer: Jackson-Pratt drain
The Jackson-Pratt drain uses a bulb that is compressed to create negative pressure, actively suctioning fluid from the wound.
Question 2: A patient develops erythema, warmth, and purulent discharge from a laparotomy incision on postoperative day 4. The MOST likely causative organism is:
- Clostridium perfringens
- Staphylococcus aureus (Correct answer)
- Pseudomonas aeruginosa
- Bacteroides fragilis
Correct answer: Staphylococcus aureus
Staphylococcus aureus is the most common cause of early postoperative surgical site infections, typically presenting within the first week.
Question 3: During abdominal surgery, the scrub technologist notices the surgeon inadvertently enters the bowel. The FIRST priority is to:
- Apply a clamp to the bowel
- Isolate the contaminated area with laparotomy sponges (Correct answer)
- Irrigate the abdomen with antibiotic solution
- Notify the circulator to open additional instruments
Correct answer: Isolate the contaminated area with laparotomy sponges
Isolating the contaminated site with laparotomy sponges prevents further spread of intestinal contents and limits peritoneal contamination.
Question 4: Which wound classification is assigned to a cholecystectomy for acute cholecystitis without perforation?
- Class I - Clean
- Class II - Clean-contaminated
- Class III - Contaminated (Correct answer)
- Class IV - Dirty-infected
Correct answer: Class III - Contaminated
Acute cholecystitis without perforation is classified as Class III (contaminated) because acute inflammation is present without a perforated viscus.
Question 5: A negative-pressure wound therapy (NPWT) device is applied to a wound. The purpose of the foam dressing placed in the wound is to:
- Absorb excess exudate directly
- Distribute negative pressure evenly across the wound bed (Correct answer)
- Prevent bacterial colonization
- Promote hemostasis at the wound edges
Correct answer: Distribute negative pressure evenly across the wound bed
The open-cell foam dressing in NPWT distributes negative pressure uniformly across the entire wound surface to promote granulation tissue formation.
Question 6: Which finding on a postoperative patient is the EARLIEST clinical indicator of anastomotic leak following bowel resection?
- Feculent peritoneal drainage
- Unexplained tachycardia on postoperative day 3-5 (Correct answer)
- Abdominal rigidity and guarding
- Fever above 39°C on postoperative day 1
Correct answer: Unexplained tachycardia on postoperative day 3-5
Unexplained tachycardia in the early postoperative period (days 3-5) is often the earliest subtle sign of anastomotic leak before overt peritonitis develops.
Question 7: When preparing an instrument set for a wound debridement of a grossly infected wound, the scrub technologist should:
- Use the same sterile field as the primary operative case
- Establish a completely separate sterile field for the debridement instruments (Correct answer)
- Place debridement instruments in a separate basin on the same field
- Use non-sterile instruments since the wound is already contaminated
Correct answer: Establish a completely separate sterile field for the debridement instruments
A separate sterile field prevents cross-contamination between clean instruments and those used in a heavily infected wound.
NBSTSA Wound Management & Surgical Complications 4
Which type of drain works by creating negative pressure to actively remove fluid from a wound cavity?