Deck 7: Sutures, sharps, and Instruments

Question 1

During the draping procedure,the anesthesia provider asked the scrub person for two towel clamps to secure the top of the unsterile edge of the drape to the intravenous (IV)poles.The scrub person had two penetrating and two nonpenetrating clamps on the back table.She knew she would need to secure the suction and electrosurgical pencil to the sterile field as soon as draping was finished.How should the scrub person respond to the anesthesia provider's request for towel clips?

A) Refuse to give him any towel clamps because they are counted.
B) Give him two Allis clamps instead.
C) Give him the penetrating towel clamps.
D) Give him the nonpenetrating towel clamps.

Answer 1

A
Anesthesia providers should actively participate in RSI prevention by not using counted items and by communicating use (and removal)of throat packs,bite guards,and so forth.The scrub person might suggest that the anesthesia provider use tape or some other type of clamp not on the sterile field to secure the drapes.

Question 2

These hemostatic devices date back to a period in time when they consisted of a product that was harvested from the ocean.They continue to be used today in every surgical procedure where a considerable amount of bleeding may be encountered and are still made of a natural product,but not from the ocean.Select the appropriate hemostatic device that fits this description.

A) Laparotomy sponges
B) Oxidized cellulose polymer
C) Bovine thrombin
D) Fibrillar gelatin fibers

Answer 2

A
Surgical sponges are used to affect hemostasis via direct pressure,absorb intraoperative blood loss and drainage,act as aids to blunt dissection,pack the viscera from the field,and keep areas of the wound moist.Laparotomy sponges (also referred to as laps,lap pads,or tapes)are either square or oblong and have a loop of colored twill tape with a radiopaque marker sewn to one corner.Used for major surgical procedures with large incisions,laparotomy sponges are presented to the surgeon either moist or dry.

Question 3

When creating a vascular anastomosis,the surgeon will typically suture one-half of the anastomosis with one-half of the suture and the other half of the anastomosis with the other half of the suture.This technique minimizes the drag and wear on the suture material and needle.The correct name for this type of suture and needle is:

A) controlled release.
B) retention.
C) double-armed.
D) multi-strand cardiovascular.

Answer 3

C
A double-armed suture is a strand of suture material with a needle on each end.Double-armed sutures are most commonly used for vascular procedures such as anastomoses and vessel repairs.

Question 4

Sharps injuries increase the risk of exposure to bloodborne pathogens in the OR.Control methods should be based on a hierarchy of impact and include elimination of the risk,using safety-engineered devices,work practice controls,and proper personal protective equipment (PPE).The most effective strategy would be:

A) developing policies and procedures.
B) the use of blunt tip suture needles.
C) eliminating the hazard.
D) creating a convenient location for PPE.

Question 5

This hemostatic device offers a rapid and secure method of clamping arteries,veins,nerves,and other small structures.It may be made of one of several metals,such as stainless steel,tantalum,or titanium.Select the correct hemostatic device that fits this description.

A) Hemostat
B) Alligator forcep
C) Ligating clip
D) Bulldog clamp

Question 6

A neutral zone is a predetermined location on the surgical field where sharps are placed for retrieval by the surgeon.Which of the following is a best practice for the use of the neutral zone?

A) Place all sharps that will be used during surgery in the neutral zone before the start of surgery.
B) Use the neutral zone for nonsharp instruments when it is the most convenient location.
C) Announce the transfer of each sharp before placing it in the neutral zone.
D) Use a hands-free area for sharps, small clamps and sponges.

Question 7

Nonabsorbable sutures are strands of material that effectively resists enzymatic digestion in living animal tissue.The USP categorizes nonabsorbable surgical suture into classes.A suture composed of monofilament or multifilament metal wire would be a:

A) Class I suture.
B) Class II suture.
C) Class III suture.
D) Class IV suture.

Question 8

Wound tissue healing is enhanced by the use of stapling instruments that mechanically apply internal staples for ligation and division,resection,and anastomoses.What feature of the mechanical process reduces tissue manipulation,edema,and inflammation?

A) The noncrushing B shape of the staples allows nutrients to pass through.
B) The titanium staples are highly reactive to tissue.
C) The staple line is contiguous and evenly spaced.
D) The staple line has consistent tension.

Question 9

The circulating nurse received the trauma call from the emergency department (ED)and called sterile supply to assemble the instruments for an abdominal trauma case with possible aortic rupture.When the cart arrived,she saw the vascular set; however,the most important instrument set was missing.What important instrument set was needed for this procedure besides the vascular set?

A) Intestinal clamps
B) Basic laparotomy set
C) Basic laparoscopy set
D) Minor set

Question 10

A male patient had a vasectomy in his urologist's office.The small incision was closed with sutures that are synthetic and will "dissolve and fall out" after 2 to 3 weeks.As the procedure ended,he heard the doctor ask the nurse for 5-0:

A) silk.
B) polyglactin.
C) plain gut.
D) chromic gut.

Question 11

A surgeon was teaching the new residents as he closed the muscle and fascia layer following an open cholecystectomy.He stated that he liked the tensile strength of this monofilamented synthetic suture,but it was hard to manage with its memory and slipperiness and normally needed six surgeon's knots to hold.He was using:

A) surgical polyester fiber.
B) polypropylene.
C) multifilament nylon.
D) surgical gut.

Question 12

Where do more than half of needlestick injuries involving suture needles occur?

A) During the suturing of fascia or muscle tissue
B) During the suturing of epithelial tissue
C) During the suturing of loose connective tissue
D) During the passing of the needle between surgical personnel

Question 13

A veteran perioperative nurse remembers a time when all suture needles had eyes,and she even had her own needle rack.She hand threaded all sutures according to the surgeon's preference.The newer sutures were originally called "atraumatic" sutures because they did not double back through a needle eye and cause tissue trauma during pulling or suturing through the tissue.Today,we call this manufacturing process of connecting the suture thread to the needle:

A) engineered crimp.
B) controlled release.
C) reverse cutting.
D) swaged.

Question 14

The ideal suture material is one that has handling characteristics such as:

A) memory.
B) slickness.
C) ease of tying.
D) removable knots.

Question 15

Perioperative team members are accountable for all of the soft goods,instruments and miscellaneous items used in surgical procedures.In the event of a count discrepancy what is the first action to be taken?

A) Exploring the incision site
B) Searching the sterile field
C) Verbally notifying the entire team
D) Ordering intraoperative imaging

Question 16

The primary use for suture is essentially to:

A) strengthen, reform, and close tissue.
B) ligate, suture, and close tissue.
C) ligate, strengthen, and stop bleeding.
D) clamp, divide, and attach tissue.

Question 17

Surgical instruments that are not considered in the category of clamps,retractors,or cutting instruments,but are used in most procedures,are typically included within the category of:

A) specialty instruments.
B) microsurgical instruments.
C) endomechanicals.
D) accessory and ancillary instruments.

Question 18

The scrub person was precepting a surgical technology student on her first orthopedic case,a tibial intramedullary (IM)rodding.The scrub person explained to the surgical technology student the importance of keeping the instruments free of blood and bioburden during the procedure and demonstrated the best practice and how to:

A) dip and agitate the instruments in saline after the surgeon returns them.
B) wipe the instruments with a sponge moistened with sterile water after each use.
C) rinse or soak the instruments in sterile water and dry them before placing on the back table.
D) wipe the instruments with a sponge moistened with sterile water after each use and rinse or soak the instruments in sterile water and dry them before placing on the back table.

Question 19

The surgeon needs a suture material that will not degrade over time but becomes encapsulated and supports a tissue structure that will continue to be exposed to pressure and stretching forces throughout the patient's life.These physical properties are best described by a suture that:

A) is nonabsorbable, has good tensile and knot strength, and is the appropriate diameter for the tissue.
B) has a large diameter, is nonabsorbable, is highly reactive, and is a monofilament.
C) is a monofilament, is synthetically manufactured, is absorbable, and has a large diameter.
D) has good tensile strength, memory, and ease of tying and is absorbable.

Question 20

A surgeon explains his justification for his suture choice to the new perioperative nurse in the scrub role.He prefers to suture his intestinal anastomosis with a suture that has multiple filaments braided together because it ties well and holds the knot,which tightens when the thread absorbs the tissue fluids.He also needs a strand that is easy to see and only needs to retain its tensile strength for about 1 year,at which time the intestinal junction will be healed,even though this suture is considered nonabsorbable.He will ask the nurse for a 24-inch 4-0:

A) multifilament nylon.
B) surgical gut.
C) polybutester.
D) silk.

Question 21

Surgical adhesives may be divided into two categories,cyanoacrylates and fibrin tissue adhesives.These adhesives are sometimes grouped together and considered the same product,but the inherent properties of each result in separate indications.Select the true statement/s about cyanoacrylic tissue adhesives.

A) They are used for superficial wound closure.
B) The mechanism of action occurs on the coagulation cascade.
C) The longer chain derivatives have decreased toxicity.
D) There is no hemostatic property
E) They are composed of two elements that activate when mixed together.

Question 22

Careful counting (according to established policy),situational awareness,and conscientious and meticulous attention to the field are believed to prevent miscounts and lost items.AORN's Guideline for Prevention of Retained Surgical Items recommends that counts should be performed:

A) when two circulators are available.
B) before closure of a cavity within a cavity.
C) during anesthesia induction.
D) prior to the patient entering the room.
E) when requested by any perioperative team member.
F) during time-out periods.

Question 23

All perioperative team members are responsible for the prevention of retained surgical items (RSIs).Unintentionally retained surgical items are felt to be completely preventable "never events." Variables associated with increased RSI risk include:

A) estimated blood loss greater than 500 mL.
B) elevated BMI.
C) an incorrect surgical count.
D) staff change.
E) involvement of more than one surgical team.

Question 24

There are many different types of suturing techniques (stitches)in wound closure and tissue approximation.Which type of stitches are used to reinforce the primary suture line with heavy,strong suture material in an obese patient with high tension on the wound closure?

A) Interrupted stitches
B) Retention stitches
C) Purse-string stitches
D) Subcuticular stitches

Question 25

Flat neurosurgical patties are flat sponges composed of soft compressed cotton or rayon with an embedded radiopaque element and string attached.They are often used in neurosurgical procedures.While used for hemostasis and exposure,what other use would be important in surgery?

A) Application of topical steroids
B) Marking of suspicious site on a specimen for frozen section
C) Filter for suction tip to prevent underlying tissue damage
D) Permanent packing to fill cranial defect