Surgical Nursing is tied with Pharmacology and Anesthesia at 13% of the VTNE. Questions test aseptic technique, instrument identification, pack preparation, intra-operative nursing, and post-operative wound care. Errors in this domain — like breaking sterile field or selecting the wrong suture — are exactly the type of scenario the exam probes.
13% of the VTNE — approximately 26 questions. Allocate roughly 13% of your total study hours here to mirror the exam's weighting.
Walk through a complete surgical setup in your head: patient assessment → pre-op meds → prep area clip and scrub → gowning and gloving → draping → instrument count → intra-op monitoring → pack-up → recovery. Testing yourself on the full sequence reveals gaps faster than flashcards on individual topics.
Aseptic Technique & Sterility
Understand what breaks sterility: reaching over a sterile field, dropping below waist level, moisture wicking through drapes, turning your back to the field. Sterile gloves are sterile only above the table edge. Items opened but unused are considered contaminated once the sterile event ends.
Surgical Instrument ID & Use
Know the major instrument categories: cutting (scalpel blades, Mayo & Metzenbaum scissors), grasping (thumb forceps, tissue forceps, Allis), clamping (hemostatic: Halsted mosquito, Kelly, Crile; intestinal: Doyen), retraction (Senn, Weitlaner, self-retaining Balfour), needle holders (Mayo-Hegar, Olsen-Hegar). Identify by function, not just name.
Pack Assembly & Sterilization
Steam autoclave: most common method; kills all microorganisms including spores. Time/temp/pressure: 121 °C at 15 psi for 15–30 min (gravity), or 132 °C for 4 min (prevacuum). Chemical/gas: EO (ethylene oxide) for heat-sensitive items. Indicators: Class 5 integrating indicators confirm sterilization conditions. Expiration: event-related (damage to packaging = unsterile).
Gowning, Gloving & Draping
Closed gloving technique maintains sterility after gowning. Open gloving used for non-scrubbed personnel assisting. Draping order: proximal to distal, starting at incision site. Quarter-drape then large drape. Fenestrated drapes placed over the field last. Count sponges and instruments before and after.
Patient Positioning
Dorsal recumbency (most common: midline surgeries), lateral (thoracotomy, orthopedic), sternal (intervertebral disk, perineal), Trendelenburg (caudal abdominal), reverse Trendelenburg (cranial). Position changes alter perfusion — note time in position and monitor blood pressure.
Hemostasis Techniques
Pressure, ligation, electrosurgery (monopolar vs. bipolar), hemostatic agents (Gelfoam, thrombin, bone wax). Electrosurgery: monopolar uses grounding pad; ensure pad placement is adequate. Bipolar is used near nerves and delicate tissue. Clip or ligate before transecting vessels.
Suture Materials, Needles & Knots
Absorbable: plain gut (fast absorption), chromic gut (slower), Vicryl (polyglactin), PDS (polydioxanone, long absorption). Non-absorbable: nylon, polypropylene, stainless steel. Needle types: cutting (skin), reverse-cutting (dense tissue), taper (viscera). Know correct suture selection by tissue type.
Electrosurgery
Cutting mode: high frequency, continuous waveform — cuts through tissue with minimal coagulation. Coagulation mode: interrupted waveform — seals vessels. Blend: combination. Grounding pad must be in full contact with clean, dry skin away from bony prominences. Water-based prep solutions are less flammable than alcohol — do not use monopolar near pooled alcohol.
Intra-op Monitoring
Monitor every 5 minutes: heart rate, respiratory rate, SpO2, ETCO2, blood pressure, temperature, plane of anesthesia, fluid rate. Document on anesthesia record. Know normal values: HR 60–120 bpm (dog), RR 8–20 bpm, SpO2 ≥95%, ETCO2 35–45 mmHg, MAP ≥60 mmHg.
Post-op Wound Care & Complications
E1 through E3 wound healing: first intention (primary closure), second intention (open wound granulation), third intention (delayed closure). Complications: seroma, dehiscence (opening), evisceration (organs protruding), infection (erythema, discharge, pain, swelling). Document incision appearance at discharge.
Recovery-Room Care
Sternal recumbency preferred after extubation. Keep warm (target 37–38.5 °C). Monitor every 5 minutes until ambulatory. Assess pain on exit from surgery. Remove ET tube when swallowing reflex returns. Watch for post-op hypotension, hypoventilation, and regurgitation.
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Frequently Asked Questions
What suture types are tested on the VTNE?
The VTNE commonly asks about absorbable vs. non-absorbable sutures, absorption timelines (plain gut fastest, PDS longest), and tissue-specific selection. Know Vicryl, PDS, nylon, and polypropylene by name and application.
What is the correct gloving technique tested on the VTNE?
Closed gloving (keeping hands inside gown sleeves during glove application) is the sterile technique for scrubbed personnel. Open gloving is used when only gloves are needed (no sterile gown), such as for minor procedures.
How do I know which sterilization method to use?
Steam autoclave is standard for most metal instruments and drapes. Ethylene oxide (EO) gas is used for heat-sensitive or moisture-sensitive items (cameras, plastics, tubing). Cold chemical sterilization (glutaraldehyde) is a high-level disinfectant, not true sterilization, used for items that cannot tolerate heat or gas.
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