2024 VTNE Surgical Nursing Exam 5

2024 VTNE Surgical Nursing Exam 5 GRADED A+ (ACTUAL EXAM ) Questions and Answers (Solved)

• A dog has dislocated his hip joint and the doctor has reduced the dislo- cation.

What can be used to hold the hip in place?Answer: Ehmer sling (The Ehmer sling is a figure-eight type of bandage that keeps the affected hindlimb in the flexed position. When the hip is dislocated, the joint capsule becomes torn. The goal of the Ehmer sling is to hold the hip joint in place after the joint has been reduced back to normal positioning to allow the joint capsule to heal. This sling provides abduction and internal rotation of the femur and flexion of the knee.)

• A 6-month old puppy has presented to the hospital with a history of severe

straining to defecate. A fecal float identifies a severe parasitic infection. An abdominal ultrasound was performed, and the doctor identified that one of the loops of intestine was telescoping into another segment of intestine. What is this called?Answer: Intussusception (This question is describing an envagination of intestine into an adjacent segment of intestine. The part which prolapses into the other is called the intussusceptum, and the part which receives it is called the intussuscipiens.Evisceration refers to the removal of organs from body, usually from the abdomen.A hydrometra is the word used to describe fluid in the uterus. If the uterus were filled with pus, it would be referred to as a pyometra. Strangulation of a loop of intestine results in a point of constriction which then impedes circulation.)

• A tibial fracture needs to be repaired. The surgeon is intending to place a bone

plate on the medial aspect of the tibia. How should the patient be positioned and prepped?Answer: Dorsal recumbency with affected leg temporarily hung until the patient is draped (The best positioning is that which will allow the surgeon good access to the proposed surgical site while ideally keeping the patient comfortable.Any time surgery is being performed on the tibia, the leg should be hung while it is being prepped for surgery. Sometimes the surgeon will prefer the leg to stay hung while performing the repair. Such an approach helps maintain retraction on the bone fragments and thus reduce the fracture. This is common practice when placing external fixators.

When placing bone plates, the surgeon will usually opt to "cut" the leg down and lay it such that the lateral side is against the surgery table. This will allow for an incision into the medial aspect of the tibia. This is the preferred location as there is not nearly as 1 / 4

much musculature on this side. This allows an easier approach and dissection, and reduces morbidity. Therefore the best answer is to have the patient in dorsal recumbency with the limb temporarily hung until the patient is draped.)

• When performing orthopedic surgery, it is sometimes necessary to advance a pin

into the medullary canal of a bone. Which of the following instruments should the surgeon be provided to advance a pin? Mallet Jacobs chuck Periosteal Freer elevator Osteotome

Answer: Jacobs chuck

• Ingesta must travel through which opening as it passes through the stom- ach into

the duodenum?

Answer: Pyloric sphincter (The pylorus connects the stomach to the upper small

intestine.The lower esophageal sphincter is between the esophagus and stomach. The anal sphincter is muscle around the anus that helps with anal tone.The duodenal papilla is a raised area that marks the opening of the common bile duct and pancreatic duct into the duodenum.

The bile duct helps connect the liver to the duodenum and carries bile from the liver to aid in digestion.)

• Clipping an abdomen for a ventral midline laparotomy is one of the more

common procedures done as a surgical nurse working with dogs and cats. Which of the following statements is most accurate?

• Only enough hair should be clipped to perform the procedure
• As long as 0.5 cm margins of clipped areas are present around the incision, the

surgeon should have no trouble The hair should be clipped from the xiphoid to the base of the pubis in all males

• The abdomen should be clipped widely with at least 2 cm margins cranial to the

xiphoid and 2 cm caudal to the pubis

• The abdomen should be clipped from the manubrium to the pubis with 2 cm

margins cranial to the manubrium and 2 cm caudal to the pubis

Answer: The abdomen should be clipped widely with at least 2 cm margins cranial

to the xiphoid and 2 cm caudal to the pubis (The abdomen should be clipped widely with at least 2 cm margins cranial to the xiphoid and 2 cm caudal to the pubis. The manubrium is the most cranial bone of the sternum and would imply clipping the chest, which is not necessary for a laparotomy. Occasionally surgical complications 2 / 4

necessitate the lengthening of an incision; in effect, it is important to clip widely to allow the surgeon the flexibility to extend the incision if necessary.)

• An emasculator tool is used in which procedure?

Answer: Castration (An emasculator is a tool used in the castration of livestock. It functions to simultaneously crush and cut the spermatic cord, preventing hemorrhaging.)

• Which describes the proper order of intestinal segments?

Answer: Duodenum, jejunum, ileum, colon (The proper order of the GI tract is: esophagus, stomach, duodenum, jejunum, ileum, cecum, colon.

The duodenum, jejunum, and ileum make up the small intestine. The cecum is the pouch that connects the small intestine to the colon (the large intestine).)

• Which of the following is NOT an indication for replacing the bandage on a dog

24 hours after a tibial fracture repair with a bone plate?

Answer: Occasional toe-touching with the limb (Occasional toe-touching after a

major fracture repair is to be expected. The other answer choices are "red-flags", and the bandage should be replaced and the incision evaluated to ensure there are no impending complications.)

• A very young puppy presents with a history of milk coming from his nose and

seems to cough and gurgle when he eats. What deformity commonly results in this presentation?Answer: Cleft palate (A common presentation for cleft palate is milk coming from a puppy's (or kitten's) nose after or during eating.

It is a defect that affects the upper lip and/or the roof of the mouth. Cleft palate can involve only the soft tissue in the back of the mouth (soft palate) or extend forward through the front of the mouth (hard palate). If there is a hole in the roof of the mouth, milk can travel out the nose while the puppy is drinking.)

• This tool is most often used for which purpose? (snookspay hook)

Answer: Finding the uterine horns (This is a picture of a spay hook. The spay hook is used to assist in locating the uterine horns so that the surgeon can find and exteriorize the ovaries while performing an ovariohysterecomy (spay).)

• Which of the following species is unable to vomit?

Answer: Horses (The correct answer is horses. Horses are unable to regurgitate or vomit; they are less likely to develop aspiration pneumonia secondary to vomiting or regurgitation while under anesthesia. Regardless, horses are kept off food for 3 / 4

approximately 12 hours prior to surgery to allow the stomach to empty. Taking this precaution may help the horse achieve better ventilation while under anesthesia.)

• The surgeon accidentally drops this clamp on the floor. You pick it up and he

asks for another one. What is the name of this instrument? (horizontal groves halfwaydown) Carmalt clamp Backhaus clamp Kelly clamp Mayo clamp

Answer: Kelly clamp (The image shows a Kelly clamp. Note that a Kelly clamp has

grooves that run perpendicular to the blades (opposite the length of the blade). The Kelly clamp is used to clamp off bleeding vessels or vascular tissues. The grooves on the Kelly run halfway down the blade. A Crile clamp looks the same except the grooves would run the entire length of the blade.

A Mayo is not a clamp, but a scissor. A Backhaus is a towel clamp.The grooves on a Carmalt clamp run parallel with the blades.)

• What structure connects the kidneys to the bladder?

Answer: Ureter (The kidneys connect to the bladder via the ureters.

The bladder excretes urine to the outside via the urethra.

The trigone is the smooth triagular region inside the bladder that is formed by the area where the ureters and urethra attach to the bladder.

The Loop of Henle is part of the nephron in the kidney.)

• Which of the following surgical instruments should never be autoclaved?

(Gauze sponges Surgical towels Surgical drills Scalpel blades Mosquito forceps ) Answer: Surgical drills (Autoclaves can be used to sterilize drapes, gowns, gauze, glassware, and most surgical instruments such as forceps, clamps, scissors, and scalpels. Heat-sensitive items that must be sterilized by other means include fiber- optic equipment, lenses, plastic, electric and pneumatic devices.)

• The surgeon asks you to please get him some gelatin foam. What will he use this

for?

Answer: He will use it to stop bleeding

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