Most of what goes wrong after surgery is preventable, and the exam knows it. These questions cover the complications to watch for and their timing, surgical site and drain assessment, balancing pain control against sedation, and why early mobility and pulmonary hygiene do more than any single medication.
Question 1
84 of 125. A postoperative patient reports severe pain unrelieved by PRN hydromorphone. The covering physician dismisses concerns as "drug-seeking." Which advocacy action addresses potential bias while ensuring pain management?
- A) A) Withhold further opioids to comply with physician assessment
- B) B) Document the physician's statement without intervention
- C) C) Reassess using a pain scale and propose a multimodal approach✓
- D) D) Suggest discharge for noncompliance with treatment
Show rationale
Objective assessment challenges bias while advancing evidence-based solutions. Distractors A-B perpetuate inadequate care by accepting biased judgment. D abandons advocacy responsibilities. Unrelieved pain and stigmatizing language require nurse advocacy through standardized assessment tools and collaborative problem-solving per pain management guidelines.
Question 2
91 of 125. A transgender patient with HIV presents with surgical site infection post-orchiectomy. The nurse overhears staff using incorrect pronouns. Which action prioritizes culturally competent care coordination?
- A) A) Correct pronouns privately and continue wound care education
- B) B) Report pronoun misuse to hospital administration immediately
- C) C) Consult LGBTQ+ liaison to develop staff training and patient support✓
- D) D) Transfer care to a facility specializing in gender-affirming services
Show rationale
Liaisons address systemic and individual needs (discriminating cues: gender identity + HIV stigma). Option A addresses disrespect but lacks systemic change. Option B may create adversarial dynamics without patient input. Option D avoids institutional responsibility. Involving a liaison (C) upholds Joint Commission standards by coordinating education and affirming care, aligning with both vulnerability factors through collaborative advocacy.
Question 3
13 of 125. During a staffing crisis, a nurse is instructed to care for eight high-acuity post-op patients alone despite voicing safety concerns. The nurse later learns a patient fell during an unanswered call light. The nurse now reports intrusive thoughts about the incident and questions their professional worth. What INITIAL nursing action aligns with moral resilience building?
- A) A) Requesting a transfer to a unit with lower patient ratios
- B) B) Participating in a structured peer debriefing session✓
- C) C) Filing an anonymous safety report to hospital administration
- D) D) Scheduling a personal mental health day to recover
Show rationale
Moral resilience develops through processing distressing events, making peer debriefing optimal. It addresses intrusive thoughts (cue) by normalizing distress and exploring ethical perspectives, per AMSN guidelines. Transferring (A) avoids systemic issues but doesn't resolve moral conflict. Safety reports (C) address institutional problems but not personal trauma. Mental health days (D) offer respite but lack proactive coping skill development. Debriefing uniquely combines emotional processing with professional identity reinforcement, targeting the nurse's eroded self-worth (cue) through shared reflection.
Question 4
20 of 125. A postoperative patient on day 3 of TPN develops tachycardia, tremors, and weakness. Pre-TPN albumin was 2.0 g/dL; current phosphate is 1.6 mg/dL. Which complication is most consistent with these findings?
- A) A) Hyperglycemia-induced osmotic diuresis
- B) B) Hypophosphatemic refeeding syndrome✓
- C) C) Essential fatty acid deficiency
- D) D) Catheter-related thrombus embolism
Show rationale
Hypophosphatemia (<2.5 mg/dL) with neurologic/muscular symptoms and pre-existing malnutrition (albumin 2.0 g/dL) indicates refeeding syndrome. TPN initiation shifts electrolytes intracellularly, causing phosphate depletion. Option A lacks polyuria/glucose elevation. Option C presents with dermatitis, not acute neuro symptoms. Option D shows respiratory distress, not tremors. ASPEN guidelines highlight phosphate monitoring in malnourished patients starting TPN.
Question 5
48 of 125. A nurse cares for a patient colonized with MRSA who underwent open abdominal surgery 72 hours ago. The patient now has a temperature of 38.6°C (101.5°F) and purulent drainage at the incision site. Which finding most strongly suggests the infection is MDRO-related rather than typical surgical site infection?
- A) A) WBC count elevated to 14,000/μL with left shift
- B) B) Vancomycin administered empirically 24 hours ago
- C) C) History of hospitalization for pneumonia 4 months prior✓
- D) D) Incision erythema extending 3 cm from the wound edge
Show rationale
Prior hospitalization within 6 months (discriminating cue) is a key MDRO risk factor per IDSA guidelines. Option A indicates infection but doesn't differentiate MDRO from non-MDRO causes. Option B reflects treatment response, not etiology. Option D suggests local inflammation but is nonspecific. Analysis of risk factors (cue: recent hospitalization) must guide suspicion for resistant organisms in post-op infections.
Question 6
70 of 125. A transgender patient admitted post-op requests no family visitors. During shift handoff, staff repeatedly use incorrect pronouns despite chart alerts. Which intervention aligns with communication preferences?
- A) A) Post pronoun reminders in the patient's room
- B) B) Escalate pronoun misuse to hospital administration
- C) C) Privately confirm pronouns and coach staff on usage✓
- D) D) Document non-compliance in staff incident reports
Show rationale
Direct confirmation and coaching (C) addresses the issue respectfully without violating the patient's privacy regarding visitors. Room postings (A) could out the patient to unintended visitors. Escalation (B) is premature without initial remediation. Incident reports (D) create adversarial dynamics. AMSN protocols emphasize immediate, respectful correction of pronoun errors as fundamental to affirming care.
Question 7
98 of 125. A postoperative patient on patient-controlled analgesia (PCA) has respirations of 8/min and is arousable only to sternal rub. Oxygen saturation is 95% on 2L NC. Which action is essential?
- A) A) Assessing pain using a numeric rating scale
- B) B) Discontinuing the PCA pump immediately✓
- C) C) Increasing oxygen flow rate to 4L
- D) D) Encouraging hourly incentive spirometry
Show rationale
Respiratory depression (RR 8/min) with diminished consciousness indicates opioid overdose from PCA, requiring immediate cessation (B) per ASPAN guidelines. Pain assessment (A) is irrelevant in an obtunded patient. Oxygen (C) addresses hypoxia but not the overdose cause. Spirometry (D) is inappropriate with depressed respirations. Oxygen saturation is currently adequate, but respiratory rate takes priority for intervention.
Question 8
20 of 125. A busy single parent with post-op complications resists discharge teaching, stating, "I'll figure it out at home." Their teen will assist care. Which strategy best supports learning?
- A) A) Teach wound care via smartphone videos the parent can access during work breaks
- B) B) Provide illustrated booklets for parent and teen to review together post-discharge
- C) C) Conduct 30-minute teaching sessions during infant nap times observed on the unit✓
- D) D) Schedule a home health nurse visit for family education within 24 hours of discharge
Show rationale
Timing teaching during observed downtime (cue: infant naps) respects situational barriers (single parenthood). Option A offers flexibility but lacks assessment. Option B assumes self-directed readiness despite avoidance. Option D delays essential pre-discharge validation. Capitalizing on teachable moments aligns with adult learners' need for just-in-time, problem-centered education.
Question 9
23 of 125. On post-op day 2 following hip replacement, a patient on a mobility pathway with obesity (BMI 38) and osteoarthritis refuses ambulation, stating, "My knee hurts too much." Vital signs are stable. Which action follows the pathway protocol?
- A) A) Delay ambulation and administer PRN analgesics
- B) B) Assist with ambulation using a walker as scheduled✓
- C) C) Notify physical therapy to reschedule for afternoon
- D) D) Perform passive range of motion exercises instead
Show rationale
Early ambulation is critical for preventing complications like DVTs. Pathway protocols require scheduled mobility despite pain, using assistive devices. Option B maintains protocol adherence. Option A risks delays leading to stiffness. Option C deviates from the scheduled pathway. Option D replaces active with passive movement, reducing benefit. Comorbidities increase complication risk, making timely ambulation non-negotiable.
Question 10
28 of 125. A registered nurse delegates blood glucose monitoring to unlicensed assistive personnel (UAP) for a diabetic patient 4 hours post-hemicolectomy who now has new-onset tachycardia (HR 122) and restlessness. The UAP reports a reading of 210 mg/dL. Which action by the RN aligns with legal delegation standards?
- A) A) Document the result and reassess in 1 hour per protocol
- B) B) Instruct UAP to repeat the test using a different glucometer
- C) C) Immediately assess the patient's oxygenation and surgical site✓
- D) D) Administer sliding-scale insulin as ordered and notify the provider
Show rationale
Postoperative tachycardia and restlessness suggest potential hemorrhage or hypoxia, requiring RN-level assessment per nursing scope. While glucose is elevated, it's secondary to acute physiological stress. Option A delays critical assessment. Option B inappropriately delegates troubleshooting to UAP. Option D addresses glucose without evaluating the underlying emergency. The RN retains liability for recognizing acute changes; delegating glucose checks doesn't transfer assessment responsibility (Nurse Practice Act §3.4).
