Identify the following instrument:

AIIMS Delhi NO- 2019

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Delhi NO- 2019

Explanation

The instrument shown is a monopolar cautery pencil, a standard tool in electrosurgery.
It is identified by its characteristic pencil-like shape, a single active electrode at the tip, and two color-coded buttons.
The yellow button is for the 'cutting' waveform, which vaporizes tissue, while the blue button is for the 'coagulation' waveform, which denatures protein to achieve hemostasis.
The use of a single active electrode means the electrical circuit must be completed by a separate return electrode (grounding pad) placed on the patient.

Option B: Bipolar cautery devices are typically shaped like forceps or tweezers, not a pencil. The current in a bipolar device flows only between the two tips of the instrument.
Option C: While the instrument is electric and pencil-shaped, 'Electric pencil' is a non-specific and colloquial term. The correct and precise medical terminology is 'monopolar electrosurgical pencil' or 'cautery pencil'.
Option D: This option is incorrect because the instrument is clearly identifiable as a monopolar cautery pencil, which is listed as Option A.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification and principles of electrosurgical instruments as background academic context rather than a clinical decision trigger.
The most critical nursing responsibility related to monopolar electrosurgery is ensuring patient safety by correctly applying the grounding pad. Improper placement can lead to severe, full-thickness burns.
Nurses in the operating room must verify the integrity of the cautery pencil's insulation before use. A crack in the insulation can cause the current to arc to non-target tissue, resulting in unintended burns.
What if? The patient has a large metal implant (e.g., a hip replacement). The grounding pad must be placed on the opposite side of the body, far from the implant, to prevent the electrical current from being diverted through the metal, which could cause deep tissue burns.

How to Approach the Question

First, carefully examine the image to identify the key features of the instrument. Note its overall shape, the number of tips, the presence of buttons, and the type of connector.
Observe that the instrument is shaped like a pencil and has a single, fine point (the active electrode).
Note the two distinct buttons on the handle, which are standard for 'cut' and 'coagulation' functions in monopolar devices.
Recall the fundamental difference between monopolar and bipolar electrosurgery. Monopolar systems use one active electrode and a separate grounding pad, while bipolar systems use a two-tipped instrument (like forceps) where the current is contained between the tips.
Based on the pencil shape and single tip, identify the instrument as monopolar.
Select the option that provides the most accurate and specific medical name for the instrument.

Concept Tested & Keywords

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E6 Gynecology Williams pp. 8, 28-53, 117-145