Chapter 4: Hemostasis, Sponges, and Drains

Question 1

A shoulder examination under anesthesia is an example of what class of wound?
A. Class 1 
B. Class 2 
C. Class 3 
D. No wound classification

Answer 1

D. No wound classification

Question 2

Choose the TRUE statement about topical hemostatic products.
A. Active hemostatic products include cellulose and gelatins
B. Fibrin sealants increase levels of fibrinogen and thrombin at a bleeding site
C. Flowables contain fibrinogen
D. Passive or mechanical hemostatic products contain thrombin

Answer 2

B. Fibrin sealants increase levels of fibrinogen and thrombin at a bleeding site

Question 3

A Penrose drain is an example of a:
A. Chest drainage system
B. Closed drainage system
C. Simple drain

Answer 3

C. Simple drain

Question 4

Choose the TRUE statement about dressings.
A. Certain dressings are definitively associated with improved outcomes
B. Primary dressings are bulkier than secondary dressings
C. Primary dressings are usually made of adherent material
D. Secondary dressings absorb discharge, protect wounds, and promote hemostasis

Answer 4

D. Secondary dressings absorb discharge, protect wounds, and promote hemostasis

Question 5

Ostomies, burns, chronic venous ulcers, and necrotizing wounds are examples of:
A. Class 1 wounds with low risk of infection
B. Complex wounds that require individualized treatment
C. Superficial surgical site infections that require antibiotic therapy
D. Wounds that require delayed primary closure

Answer 5

B. Complex wounds that require individualized treatment

Question 6

Use of the Center for Disease Control and Prevention’s Surgical Wound Classification System
A. Adds significant time to operative procedures
B. Enables comparison of infection rates and assessment of infection risk
C. Is recommended primarily for complex or high-risk wounds
D. Must be performed by a surgeon

Answer 6

B. Enables comparison of infection rates and assessment of infection risk

Question 7

Which statement(s) is/are true about drains (select all that apply):
A. Drains are used primarily to obliterate dead space and remove harmful material, and when hemostasis is uncertain
B. A hemovac drain is passive, using gravity or capillary action to remove fluid from the wound
C. Active drains have a reservoir that can be collapsed to create negative pressure that draws fluid from the wound into the reservoir
D. Single lumen sump drains are connected to external suction

Answer 7

A. Drains are used primarily to obliterate dead space and remove harmful material, and when hemostasis is uncertain
C. Active drains have a reservoir that can be collapsed to create negative pressure that draws fluid from the wound into the reservoir
D. Single lumen sump drains are connected to external suction

Question 8

Mechanical methods to achieve hemostasis include which of the following (select all that apply):
A. Hemostats
B. Collagen sponges
C. Laser
D. Ligatures
E. Fibrin sealants

Answer 8

A. Hemostats and

D. Ligatures

Question 9

The perioperative nurse who is circulating for an excisional breast biopsy should anticipate the need to add which type of drain to the sterile set-up:
A. T-Tube
B. Hemovac
C. Jackson-Pratt
D. Penrose

Answer 9

C. Jackson-Pratt

Question 10

Disadvantages of a penrose drain include (select all that apply):
A. Often are manufactured using latex and would be contraindicated in those with latex allergy
B. Allow for active drainage of surgical wounds
C. Provide a pathway for microorganisms to be introduced into the wound
D. Do not allow for accurate measurement of drainage

Answer 10

A. Often are manufactured using latex and would be contraindicated in those with latex allergy
C. Provide a pathway for microorganisms to be introduced into the wound
D. Do not allow for accurate measurement of drainage

Question 11

Sponges for counting should be arranged in sponge counter bags off the field as follows:
A. 10 laps per bag, 5 raytecs per bag
B. 5 laps per bag, 10 raytecs per bag
C. However the surgeon prefers
D. None of the above

Answer 11

B. 5 laps per bag, 10 raytecs per bag

Question 12

Describe how/what this drain is used for:

Penrose drain

Answer 12

Drainage is pulsed along outside the drain by capillary action and gravity into dressing

Question 13

Describe how/what this drain is used for:

Nasogastric tube

Answer 13

aspirates gastric contents/decompresses the intestinal tract post op

Question 14

Describe how/what this drain is used for:

T-tube

Answer 14

drains the common bile duct through the abdominal wall

Question 15

Describe how/what this drain is used for:

Suction Drain

Answer 15

drains accumulated blood from operative site, uses mechanical suction to pull blood and fluid into the reservoir

Question 16

Describe how/what this drain is used for:

Chest tube

Answer 16

restores an airtight pleural cavity and maintains negative pressure, uses a water seal system connected to a source of suction

Question 17

When do you count sponges?

Answer 17

Before procedure, before closure of a cavity, at wound closure, at skin closure, at permanent relief or a scrub or circulator

Question 18

Describe the specific method to control bleeding:

Mechanical Method: Pressure

Answer 18

Manual using hands, digits, sponges or packs

Question 19

Describe the specific method to control bleeding:

Mechanical Method: Hemostats

Answer 19

Clamps used to compress blood vessels and hold small amount of tissue

Question 20

Describe the specific method to control bleeding:

Mechanical Method: Ligating clips

Answer 20

Small staple like devices that are placed around the lumen of a vessel/structure

Question 21

Describe the specific method to control bleeding:

Mechanical Method: Ligature

Answer 21

Strand of material tied around a blood vessel to occlude the lumen

Question 22

Describe the specific method to control bleeding:

Mechanical Method: Pledget

Answer 22

Non absorbable suture support that is used when there is a possibility of sutures tearing through tissue

Question 23

Describe the specific method to control bleeding:

Thermal Method: Argon Beam Coagulator

Answer 23

Delivers radio frequency electrical energy to tissue across a jet of argon gas

Question 24

Describe the specific method to control bleeding:

Thermal Method: Electrosurgery

Answer 24

monopolar mode is used for coagulation, electrical current applied through patient’s tissue

Question 25

Describe the specific method to control bleeding:

Thermal Method: Laser

Answer 25

Beam of light that is intense and concentrated and is able to cut and coagulate at the same time with minimal destruction to surround tissue

Question 26

Describe the specific method to control bleeding:

Chemical method: Microfibrillar collagen

Answer 26

Used as an adjunct to hemostasis when control of bleeding by ligature or conventional methods is ineffective or impractical

Question 27

Describe the specific method to control bleeding:

Chemical method: Oxidized cellulose

Answer 27

Absorbs 7-8 times its weight in blood, producing a clot

Question 28

Describe the specific method to control bleeding:

Chemical method: Collagen sponge

Answer 28

Dehydrated hemostatic sponge or foam available compressed or as a powder

Question 29

Describe the specific method to control bleeding:

Chemical method: Gelatin sponge

Answer 29

Sponge swells forming a clot and absorbs 40-50 times its weight

Question 30

Describe the specific method to control bleeding:

Chemical method: fibrin sealant

Answer 30

derived from human and animal blood products, forms a stable clot

Question 31

Describe the specific method to control bleeding:

Chemical method: phenol solution

Answer 31

used for sclerotherapy therapy of hemorrhoids. Some surgeons use it to cauterize the lumen of the appendix stump as it is cut off

Question 32

Describe the specific method to control bleeding:

Chemical method: thrombin

Answer 32

accelerates coagulation of blood and controls capillary bleeding

Question 33

Describe the specific method to control bleeding:

Chemical method: styptics

Answer 33

Causes blood vessels to constrict

Question 34

What are the steps a perioperative RN should take if a count is done and a sponge is missing?

Answer 34

Verbal acknowledgement and inform team, search the area, suspend closure of the wound until found, xray if it cannot be found