Surgical and procedural nursing falls heavily under the Patient/Care Management domain, which makes up 32% (40 items) of your scored test. You must know how to manage chest tubes, monitor moderate sedation, and handle blood transfusion reactions. Test your clinical judgment with our bank of 4100+ practice questions.
Question 1
21 of 125. An alert patient requiring urgent appendectomy states they're Jehovah's Witness and refuse blood products. Their adult son demands the nurse "override this refusal" to permit transfusions if needed post-op. Which response adheres to consent principles?
- A) A) Document the son's request and proceed with surgery without transfusion consent
- B) B) Delay surgery until hospital legal team resolves the family conflict
- C) C) Honor the patient's refusal after confirming understanding of risks✓
- D) D) Obtain consent from the son as next of kin for transfusion decisions
Show rationale
Competent adults retain refusal rights even in emergencies per AMSN ethics guidelines. Option C respects autonomy after verifying comprehension. Option A violates refusal rights. Option B inappropriately delays urgent care. Option D disregards the patient's explicit directive. Cues (urgent surgery, religious refusal) highlight the primacy of informed refusal over family pressure.
Question 2
55 of 125. A bariatric patient's bed exit alarm activates repeatedly. The patient has dementia and a new hip incision but denies pain. Which equipment adjustment balances safety and mobility needs?
- A) A) Apply vest restraint to prevent unintended bed exits temporarily
- B) B) Lower bed height and place floor mats while evaluating alarm sensitivity✓
- C) C) Disable alarm and assign 1:1 sitter for continuous observation
- D) D) Increase alarm volume threshold to reduce false notifications
Show rationale
Hip incision (cue: mobility risk) and dementia require fall prevention without restraints. Option B modifies environment proactively while troubleshooting alarm sensitivity per safe patient handling standards. Option A uses restraints, which increase agitation/injury risk in dementia. Option C removes equipment safety redundancy. Option D increases fall risk by desensitizing alarms. AMSN guidelines prioritize least restrictive interventions and equipment calibration for high-risk patients.
Question 3
77 of 125. During cystoscopy under moderate sedation with fentanyl and midazolam, a diabetic patient (HbA1c 8.6%) develops diaphoresis and heart rate 120 bpm. Capnography shows EtCO2 32 mmHg. Which action reflects appropriate interpretation of monitoring data?
- A) A) Administer 50% dextrose IV for suspected hypoglycemia✓
- B) B) Give naloxone 0.4mg IV for opioid-induced bradycardia
- C) C) Increase sedation depth to reduce sympathetic response
- D) D) Provide 500mL IV bolus for hypovolemic tachycardia
Show rationale
Diaphoresis and tachycardia in a diabetic with low EtCO2 (indicating tachypnea) suggest hypoglycemia. Dextrose addresses this immediately per ADA guidelines. Naloxone (B) is incorrect as tachycardia opposes opioid toxicity. Increasing sedation (C) worsens instability. Fluid bolus (D) ignores metabolic cues; EtCO2 suggests hyperventilation, not hypovolemia.
Question 4
89 of 125. A trauma patient with hemorrhagic shock receives 4 units of packed RBCs. Thirty minutes later, they report back pain, have a temperature of 39°C (102.2°F), and produce cola-colored urine. BP is 90/60 mmHg. Which action takes priority?
- A) A) Send blood for type and crossmatch
- B) B) Administer IV furosemide 40 mg
- C) C) Stop the transfusion immediately✓
- D) D) Obtain a stat chest X-ray
Show rationale
Fever, back pain, and hemoglobinuria indicate acute hemolytic reaction from ABO incompatibility. AABB standards mandate stopping transfusions first to prevent renal failure/DIC. Distractor A delays crisis management; B may be used later for renal protection; CXR (D) doesn't address the emergency. Hypotension exacerbates the reaction. Rapid discontinuation limits antigen-antibody interaction more than diagnostics or diuresis.
Question 5
105 of 125. Four hours after thoracotomy, a patient's chest tube drainage system has no tidaling. Breath sounds are absent on the affected side, and oxygen saturation dropped to 88%. The nurse observes no air leaks in the system. Which complication should the nurse suspect?
- A) A) Tension pneumothorax due to dislodged tube
- B) B) Hemothorax from surgical site bleeding
- C) C) Bronchopleural fistula causing air leakage
- D) D) Drain obstruction by a fibrin clot✓
Show rationale
Absent tidaling with desaturation and diminished breath sounds suggests tube occlusion preventing air/fluid evacuation, not active bleeding (B) or fistula (C). Tension pneumothorax (A) typically shows continuous bubbling. Clot obstruction aligns with immediate post-op timing and absence of air leaks. CMSRN protocols mandate checking for kinks/clots before assuming displacement.
Question 6
110 of 125. A diabetic patient with septic shock from a perforated diverticulum 48 hours post-op has MAP 55 mmHg despite 3 L crystalloid. Lactate is 5.2 mmol/L, and ScvO₂ is 58%. Which intervention is indicated next?
- A) A) Administer IV insulin to achieve glucose <180 mg/dL
- B) B) Start norepinephrine infusion at 0.05 mcg/kg/min✓
- C) C) Transfuse packed red blood cells to Hgb >10 g/dL
- D) D) Order a stat CT abdomen to locate infection source
Show rationale
Persistent hypotension and lactic acidosis after fluids require vasopressors per Surviving Sepsis Campaign guidelines. Norepinephrine is first-line for septic shock. Distractor A addresses hyperglycemia but not perfusion; C is for hemorrhage, not sepsis; D delays hemodynamic stabilization. ScvO₂ <70% confirms inadequate oxygen delivery, necessitating vasoactive support before imaging or glycemic control.
Question 7
119 of 125. A post-MH patient requires emergency appendectomy 6 months later. Which preoperative preparation is critical?
- A) A) Administer oral dantrolene 24 hours preoperatively
- B) B) Ensure a non-triggering anesthetic machine is available✓
- C) C) Premedicate with acetaminophen for fever prevention
- D) D) Schedule surgery in an ICU for continuous monitoring
Show rationale
MH-safe anesthesia (avoiding volatiles/succinylcholine) is the cornerstone of prevention per American Society of Anesthesiologists guidelines. Prophylactic dantrolene (A) isn’t routinely recommended. Acetaminophen (C) doesn’t prevent MH. ICU scheduling (D) is unnecessary with proper precautions. The history of prior MH is the key risk discriminator.
Question 8
3 of 125. During pre-op teaching for colectomy, a non-English-speaking patient nods while a family member translates. The nurse notes the family member omits stoma care details. What action ensures valid consent?
- A) A) Accept the consent as valid since family-assisted translation is common
- B) B) Provide written materials in the patient's language for later review
- C) C) Stop the process and arrange professional medical interpreter services✓
- D) D) Verify understanding by asking the patient to demonstrate stoma care
Show rationale
CMS mandates professional interpreters to prevent critical omissions; family members aren't substitutes. Option C addresses the translation error directly. Option A risks uninformed consent. Option B delays clarification pre-signature. Option D is impractical pre-operatively and doesn't fix translation gaps. Cues (omission of key details, non-English-speaking) trigger interpreter requirements under Title VI.
Question 9
20 of 125. In a colectomy case with unexpected conversion to open surgery, the scrub nurse realizes a Kelly clamp is missing during the final instrument count. The patient has dense adhesions from prior abdominal radiation. The surgeon is closing the peritoneum. What action best addresses this situation?
- A) A) Notify the surgeon and initiate methodical wound cavity exploration✓
- B) B) Delay closure to re-count instruments from all storage zones
- C) C) Proceed with closure and order an abdominal X-ray in recovery
- D) D) Document the discrepancy as unavoidable given emergent conversion
Show rationale
With the peritoneum still open, direct exploration is feasible and recommended by AORN before cavity closure. Prior radiation increases adhesion risks where instruments may lodge, making visual/manual search optimal. Option B wastes time when the cavity remains accessible. Option C risks retained object complications. Option D violates count resolution protocols. Cues are peritoneal closure stage and adhesion history, requiring immediate field examination while accessible.
Question 10
24 of 125. Four hours after total knee replacement, a patient on enoxaparin for atrial fibrillation develops a systolic BP drop from 130 to 98 mmHg, HR 110 bpm, and pale, clammy skin. The surgical dressing is intact with minimal drainage. Which action aligns with current hemorrhage management guidelines?
- A) A) Administer IV epinephrine 1:10,000 immediately
- B) B) Increase the oxygen flow rate to 6 L/min via nasal cannula
- C) C) Initiate a 1,000 mL bolus of lactated Ringer’s solution✓
- D) D) Obtain a stat hemoglobin and hematocrit level
Show rationale
Tachycardia, hypotension, and diaphoresis suggest hypovolemic shock from possible internal hemorrhage. Anticoagulation increases bleeding risk. Fluid resuscitation per Advanced Trauma Life Support (ATLS) precedes diagnostics. Distractor A is for anaphylaxis or cardiac arrest; B addresses oxygenation but not volume loss; D delays critical intervention. AABB standards emphasize rapid volume expansion before lab testing in acute hemorrhage.
Question 11
28 of 125. A 78-year-old patient with mild vascular dementia (MMSE 22/30) arrives for elective hernia repair. They correctly state the procedure name but cannot recall risks discussed. Their daughter insists surgery proceed, stating she holds healthcare POA. Which action reflects appropriate consent management?
- A) A) Proceed with surgery since the daughter holds legal authority as POA
- B) B) Defer surgery and consult psychiatry for formal capacity assessment
- C) C) Have the surgeon re-explain risks and reassess patient understanding✓
- D) D) Obtain consent from both patient and daughter as dual decision-makers
Show rationale
Mild dementia doesn't automatically negate capacity; the patient's partial recall warrants reassessment per Joint Commission standards. Option C addresses this by reevaluating comprehension. Option A ignores the patient's potential capacity despite POA. Option B is premature without targeted re-education. Option D violates the patient's autonomy rights if they retain capacity. The cues (elective surgery, partial recall) support optimizing patient participation before surrogate reliance.
Question 12
42 of 125. An 80-year-old with heart failure (EF 30%) and chronic kidney disease (creatinine 2.2 mg/dL) develops acute confusion 48 hours after bowel resection. Vital signs show HR 120 bpm, BP 88/50 mmHg, and SpO₂ 89% on 2L NC. Which action aligns with current PE management guidelines?
- A) A) Administer IV heparin bolus immediately
- B) B) Obtain stat CT pulmonary angiography
- C) C) Start high-flow oxygen via non-rebreather mask✓
- D) D) Position supine with legs elevated
Show rationale
Hypoxemia and hypotension indicate hemodynamic instability from possible PE. Oxygen is the priority to prevent tissue hypoxia while diagnostics proceed. ACCP guidelines emphasize stabilizing airway/breathing before anticoagulation or imaging. Option A is contraindicated with active bleeding risk (recent surgery). Option B is critical but requires hemodynamic stability first. Option D may worsen dyspnea in heart failure. Oxygen addresses the most immediate threat to survival.
Question 13
54 of 125. A telemetry monitor alarms "ARTIFACT" in a stroke patient with atrial fibrillation (HR 140) who suddenly becomes unresponsive. Electrodes are intact, but limbs show tremors. Which step is most urgent?
- A) A) Replace all telemetry electrodes to obtain accurate rhythm reading
- B) B) Perform pulse check at carotid artery while calling rapid response✓
- C) C) Administer prescribed PRN diltiazem to control rapid ventricular rate
- D) D) Reposition limb leads away from muscles to reduce motion artifact
Show rationale
Unresponsiveness (cue: sudden LOC) with known AFIB suggests possible arrest or stroke complication, overriding artifact concerns. Option B validates cardiac status immediately via pulse check while activating emergency support per ACLS. Option A/D focus on equipment during clinical deterioration. Option C administers medication without confirming actual rhythm due to unreliable monitor. CMSRN protocols mandate direct patient assessment when alarms conflict with clinical status.
Question 14
120 of 125. A nurse is assisting with a bedside thoracentesis for a patient with metastatic lung cancer and severe COPD. During the procedure, the patient develops subcutaneous emphysema and oxygen saturation drops to 88%. Which action by the nurse aligns with procedural scope?
- A) A) Administering supplemental oxygen via non-rebreather mask at 15 L/min✓
- B) B) Performing immediate needle decompression at the second intercostal space
- C) C) Adjusting the sedation dosage to reduce respiratory depression
- D) D) Ordering a stat chest X-ray to confirm pneumothorax
Show rationale
Administering oxygen (A) is within nursing scope for acute hypoxia during procedures. Needle decompression (B) exceeds scope as it's an advanced provider intervention. Sedation adjustment (C) requires anesthesia provider collaboration per guidelines. Ordering diagnostics (D) is a provider responsibility. Cues (COPD, metastatic cancer) increase pneumothorax risk, but initial nursing action focuses on stabilizing oxygenation while activating emergency response. Distractors represent either scope overreach (B,D) or inappropriate independent action (C) during acute events.
Question 15
21 of 125. On postoperative day 5 after prostatectomy, a patient with metastatic cancer develops pleuritic chest pain. D-dimer is elevated, but CT angiogram is negative for PE. Which factor most strongly suggests alternative VTE testing?
- A) A) Platelet count of 450,000/mm³
- B) B) History of heparin-induced thrombocytopenia✓
- C) C) Subtherapeutic INR on warfarin
- D) D) Oxygen saturation of 94% on room air
Show rationale
HIT increases risk for thrombosis despite negative imaging, requiring alternative diagnostics like venous ultrasound per ACCP guidelines. Option A indicates reactive thrombocytosis, not directly VTE-related. Option C reflects anticoagulation management, not diagnostic need. Option D is common in many post-op conditions. HIT necessitates further investigation for occult DVT/PE due to paradoxical hypercoagulability.