Surgical Nursing: free VTNE practice questions

A stab incision goes in point first, and the No. 11 is the blade tapered to a pointed shape - that taper is why it is the blade generally used to create a stab incision. The No. 10 is the tempting wrong answer for a real reason: it is the most common scalpel blade used in small animal surgery, so it is usually the blade already sitting on the handle, but it is used primarily for skin incisions rather than for entering at a point. The No. 15 has the appearance of a No. 10 with only half its length, which invites the reasoning 'small opening, so use the small blade' - it is a shortened version of the skin incision shape, not a pointed one. The No. 12 resembles a hook, with its cutting edge on the inside of the curve, and is often used to declaw a cat; that shape and edge placement suit a different job entirely. One more piece of the same set is worth carrying: the larger blades, Nos. 20 through 23, are generally reserved for large animal surgery, so none of them belongs on a small animal table.

A 4 x 4-inch sponge holds approximately 10 mL of blood and a 3 x 3-inch sponge holds approximately 6 mL, so the soaked sponge count doubles as a running estimate of how much blood the patient has lost. Four large sponges give 4 x 10 = 40 mL and four small ones give 4 x 6 = 24 mL, for a total of about 64 mL. Every wrong option here is a specific tallying error worth recognizing. 40 mL counts only the 4 x 4s and ignores the smaller sponges; 24 mL is the mirror error, counting only the 3 x 3s; 80 mL applies the 10 mL figure to all eight sponges without allowing for the two different sizes. Two practical points sit behind the arithmetic. First, it is only an estimate, and it only works if the sponges are genuinely soaked and none have been discarded uncounted - which is one more reason the sponge count is done carefully. Second, how the sponge is used affects hemostasis itself: bleeding tissue should have firm, but not excessive, pressure applied with the sponge rather than being wiped, because wiping with a sponge may pull away coagulation that has already started. Ideally only radiopaque sponges are included in surgical packs; the cheaper nonradiopaque gauze is for routine external use.

Pain and blood loss look alike in a patient coming out of anesthesia, and that overlap is the whole difficulty of the immediate postoperative period. A painful recovering animal can show continued hypothermia and a further drop in body temperature, a rapid heart rate with weak peripheral pulses, a rapid respiratory rate, and pale or even white mucous membranes - which is exactly the picture substantial blood loss produces. So options A, B and C are all genuine findings and all still useless for this particular decision, because either explanation accounts for them.

Option B is the most tempting of the three, since pale to white membranes are taught so firmly as the sign of blood loss. They are, but a painful recovery produces the same membranes, so the finding belongs in the overall picture and does not separate the two possibilities. What does separate them are the findings that show where blood is actually going: swelling or oozing of blood at the incision, enlargement of the abdomen when the bleeding is intra-abdominal, and dyspnea with decreased lung sounds when it is intrathoracic. An abdomen that is visibly bigger than it was at the end of the procedure is that kind of localizing sign, and pain does not produce it. Report any such abnormality to the surgeon immediately, and record the patient's clinical signs frequently, because it is the change from one set of observations to the next that shows what is happening.