VTNE Surgical Nursing Procedures Questions and Answers — Questions and Answers
Question 1: What are the standard time, temperature, and pressure settings for sterilizing most routine surgical packs in a gravity-displacement steam autoclave?
- 10 minutes at 115°C (240°F) and 10 psi
- 15 minutes at 121°C (250°F) and 15 psi (Correct answer)
- 20 minutes at 100°C (212°F) and 20 psi
- 5 minutes at 132°C (270°F) and 30 psi
Correct answer: 15 minutes at 121°C (250°F) and 15 psi
The generally accepted standard for steam sterilization in a gravity-displacement autoclave is exposure to 121°C (250°F) at a pressure of 15 psi for a minimum of 13-15 minutes. The 5-minute cycle is typically reserved for "flash" sterilization of unwrapped instruments in a pre-vacuum sterilizer.
Question 2: A 4-year-old Golden Retriever is scheduled for a tibial plateau leveling osteotomy (TPLO) on its right hind limb. When preparing the surgical site, what is the most appropriate area to clip and aseptically prepare?
- A small square patch directly over the stifle joint.
- From the mid-femur to the mid-tibia, clipping only the lateral aspect.
- A full circumferential clip from the level of the hip to the tarsus. (Correct answer)
- The area from the stifle to the foot, including the paw.
Correct answer: A full circumferential clip from the level of the hip to the tarsus.
Orthopedic procedures like a TPLO require a very large and wide sterile field to allow for manipulation of the limb during surgery and to minimize the risk of contamination. The standard practice is to perform a full circumferential clip from the joint above (hip/coxofemoral joint) to the joint below (hock/tarsus).
Question 3: During an ovariohysterectomy, the surgeon needs to securely clamp the ovarian pedicle, which contains blood vessels and tissue. Which of the following hemostatic forceps is specifically designed for this purpose with longitudinal serrations and a cross-hatched tip?
- Halstead mosquito forceps
- Kelly hemostatic forceps
- Allis tissue forceps
- Rochester-Carmalt forceps (Correct answer)
Correct answer: Rochester-Carmalt forceps
Rochester-Carmalt forceps are large, crushing hemostats characterized by longitudinal serrations along the jaw and cross-hatching at the tip. This design allows them to securely grasp and crush large tissue bundles, such as an ovarian pedicle or uterine stump, preventing slippage while minimizing tissue cutting.
Question 4: A surgeon requests a non-absorbable, monofilament suture for skin closure on a cat, which will need to be removed in 10-14 days. Which of the following suture materials best fits this description?
- Nylon (e.g., Ethilon) (Correct answer)
- Polyglactin 910 (e.g., Vicryl)
- Polydioxanone (e.g., PDS)
- Surgical Gut (Chromic)
Correct answer: Nylon (e.g., Ethilon)
Nylon is a synthetic, non-absorbable monofilament suture commonly used for skin closure that requires later removal. Polyglactin 910 and Polydioxanone are both absorbable synthetic sutures, and Surgical Gut is an absorbable natural suture.
Question 5: During an abdominal exploratory, a non-scrubbed circulating nurse accidentally leans over the sterile instrument table, and their arm makes brief contact with a sterile drape covering a section of unused instruments. What is the most appropriate immediate action?
- Spray the area with sterile saline and continue the procedure.
- Ignore the contact as it was brief and unlikely to cause contamination.
- Immediately notify the surgeon and cover the contaminated drape and instruments with another sterile drape. (Correct answer)
- Remove all instruments from the table and replace them with a new sterile pack.
Correct answer: Immediately notify the surgeon and cover the contaminated drape and instruments with another sterile drape.
Any contact between a non-sterile object and a sterile field results in contamination. The correct protocol is to acknowledge the break in asepsis immediately and isolate the contaminated area by covering it with another sterile barrier, thereby preserving the sterility of the rest of the field. Ignoring it is a major breach, and replacing the entire setup is often unnecessary and inefficient if the contamination is localized.
Question 6: A 2-year-old dog is presented for a 5-day post-operative recheck after a routine castration. The owner reports the dog has been excessively licking the incision. Which of the following clinical findings is the most definitive sign of surgical wound dehiscence?
- Moderate swelling and redness (erythema) around the incision line.
- Separation of the incision edges with subcutaneous tissue visible. (Correct answer)
- A small amount of dried serosanguinous discharge (crusting) on the sutures.
- The dog showing signs of pain upon palpation of the surgical site.
Correct answer: Separation of the incision edges with subcutaneous tissue visible.
Wound dehiscence is defined as the separation or opening of a surgical wound's edges before it is fully healed. While redness, swelling, minor discharge, and pain can be signs of inflammation or infection, the actual visible separation of the wound layers is the hallmark sign of dehiscence.
VTNE Surgical Nursing Procedures Questions and Answers
What are the standard time, temperature, and pressure settings for sterilizing most routine surgical packs in a gravity-displacement steam autoclave?