Zander Test Bank Practice Exam
Questions And Verified Answers
2025/2026
SmalljBoweljObstructionj(SBO)j-jans-
•Definition:jinabilityjofjthejboweljtojfunctionjeitherjfromjajmechanicaljproblemjorjajfuncti
onaljproblem
•Mechanicalj-outside:jadhesions
•Mechanicalj-inside:jtumor
•Functionalj-lack/slowjofjperistalsis
-AKAjparalyticjileus
Pathophysiologyj-jans-
•Gas,jtissue,jfecesjgatherjproximaljtojthejblockagej(jcouldjbejatjonejorjmorejsegmentsj
ofjbowel)jthisjgatheringjorjaccumulationjthenjdistendsjthejbowel.
•Swallowedjair,jfluidjfromjIVjspace,jgastricjjuices,jpancreaticjjuicesjbecomejstuckjinjthe
jGIjtract
•Increasedjgasjduejtojbacterialjaction/stasis
Increasedjintraluminaljpressurej-jans-
•Anyjincreasingjvolumejinjajclosedjspacejwithjdojthat!!!
•Lackjofjabsorptionjofjnutrientsjetc
•Edemajofjthejintestinaljwall,jthejincreasedjcapillaryjpermeability
•Upjtoj10jLjcanjmovejintojthejlumenjfromjthejIV/ISjspaces
Mechanical/strangulatedjherniaj-jans-•Largejamountsjofjischemiajinflammation/
necrosisjaffectjajportionjofjthejboweljandjcanjleadjtojperitonitis
•Peritonitis-
severejinfectionjofjthejnormallyjsterilejabdominaljcavityjthatjsurroundsjthejorgans
Severejcases:j-jans-•Thirdjspacingjisjsevere
•Distensionjisjsevere
•Fluidjvolumejdeficitjisjsevere
•SHOCKjpossiblejhere!!!
Functional/ileusj-jans-
•Etiology:jhandlingjofjboweljduringjsurgery,jsojpostjopjsomewhatjcommon
,•Blood,jmicroorgnaisms,jcanjalsojslowjthejperistalsisjwhenjtheyjcomejintojcontactjwithj
thejintestinejinjthejPjcavity
•Hypokalemia,juremia,jSCIs,jnarcotics
•Anticholinergics:jsometimesjinjclientsjinjthejpsychjfield
Signs/symptomsj-jans-Varyjdependingjonjleveljandjseverity/
completeness:jelectrolytejimablance
Crampy/colickyjabdominaljpain,jintermittentjorjcontinuous
Vomiting-especiallyjinjhigh,jcanjbecome
taste/
oderjofjfecesj(feculent)j(bacterialjfermentationjwithjstagnantjGIjcontents,jmorejcommon
jinjlowerjlevels)
Sj&Sjcontinuedj-jans-
•BelowjthejO,jthejboweljmayjemptyjearlyjon,jbutjlaterjtherejwilljbejnojstools/gas
•Borborygmi,jhighjpitchedjsounds
-Duejtojheroicjeffortjofjintestinejtojmovejthejobstruction....thisjisjearly
-Latej-boweljsoundsjarejabsent
Sj&jSofjajSBOj-jans-
•Observationjofjabdomenjbeforejpalpationjmayjshowjvisiblejwavesjofjmovementjacross
jthejthinjabdomen,jduejtojthejsmoothjmusclejtryingjveryjhardjtojmovejthejsegment/
Ojalong
•Distention:jminimaljwithjproximaljandjgreatjwithjdistal
•Tenderness
Latejsignsjmayjindicatejshockj-jans-
•Tachy,jlowjbloodjpressure,jTjelevation,joliguria,jtachypnea
•Hypovolemicjshockjduejthirdjspacingjandjvomitingjetc.
Complicationsj-jans-•Hypovolemiajandjshock
•MODS
•Renaljinsufficiency/failure/
•Atelectatis/pneumonia
•Peritonitis/gangrene/perforation/septicjshock
•Mortalityjreatej10%jinjSBO
•Withjstrangulation:jupjtoj20-75%
Diagnosticsj-jans-•WBC
•Serumjamylase
•Serumjosmolality/lytes
•ABGs
•Abdominaljflatjplate
•CTjwithjcontrastjmedia:jcheckjiodinejallergies
•Bariumjenema/jsigmoidoscopy/colonoscopy
,Medicaljtreatment/conservativej-jans-•GIjdecompressionjwithjNGjtubes
•Boweljrest
•ProkineticjAgents-REglan?
jForjputtingjtubejdownjifjpyloricjvalvejdoesjnotjcooperate,jcisapridej(Propulsid?)
•Anti-emetics-
TreatmentjAggressivejSurgicalj-jans-
•Requiredjforjcompletejmechanicaljandjforjstrangulated/incarcerated
•Laporotomy
•Removejadhesions
•Tumorjresection
•Boweljresectionjforjgangrenousjsegments
•Anastomosis
NursingjDiagnosisj-jans-•FVDjr/tjsequestrationjofjfluidjinjboweljandjvomiting
•Ineffectivejtissuejperfusion:jGIjr/tjpossiblejstrangulation/distention
•Ineffectivejbreathingjpatternjr/tjabdominaljdistention
Outcomesj-jans-•Fluidjbalance
•Effectivejventilation/breathing
•EffectivejTissuejperfusion:GI
•Painjcontrol
•Balancedjnutrition
•Wound/incisionjHealed:jprimary/secondary
Interventionsj-jans-•Analgesics/PCA
•Fluidjmanagement
•Nutritionjmonitoring
•Positioning
•Respiratoryjmonitoring/splinting
•Incisionjcare/woundjcare
HealthjPromotion:jPrimaryj-jans-•Dietaryjintake:jfiber,jfluid,
•Exercise
•AvoidjpopcornjifjvulnerablejtojseveraljSBOs
HealthjPromotion:Secondaryj-jans-
•Earlyjseekingjofjmedicaljassistancejforjabdominaljpain,jnausea,jvomiting,
•AbjWhatjWoundjclassificationjforjvaginaljhysterectomy?
a.jClassjI
b.jClassjII
c.jClassjIII
d.jClassjIVj-jans-B.jTherejisjcontrolledjentryjintojthejgenitourinaryjtract.
, Alexander'sjCarejofjthejPatientjinjSurgeryj16thjed.jChj9
ThejCRNAjisjattemptingjtojopenjthej25-year-
oldjman'sjmouthjforjintubationjbutjthejjawjisjtightjandjshe'sjhavingjdifficulty.jthejnursejn
oticesjthatjthejpatient'sjcapnographjisjrisingjdramaticallyjasjthejCRNAjcontinuesjtojstru
gglejtojopenjthejjawjtojintubatejandjthejpatient'sjheartjratejandjbloodjpressurejarejrisin
g.jwhatjisjthejappropriatejresponsejforjthejperioperativejnurse?
a.jThejanesthesiajisjtoojlight,jandjthejpatientjisjconfusedjandjstrugglingjagainstjthejCR
NAjthejperioperativejnursejsuggestsjgivingjmorejsedation
b.jThesejarejsignsjofjmalignantjhypothermiajthejperioperativejnursejtellsjthejCRNAjwh
atjshe'sjseeing.jthejperioperativejnursejcallsjthejorjdeskjtojaskjforjhelpjandjthejMHjcart
jbejbroughtjtojthejroom.
c.jthejpatientjisjhavingjanjallergicjreactionjtojajmedication.jthejperioperativejnursejinfor
msjanesthesiajproviderjandjassistsjaccordingly
d.jMASSETEERjspacejmusclejrigidityjalsojknownjasjMMRjisjnotjunj-jans-
B.jThesejarejearlyjsignsjofjMalignantjHyperthermia.jMMRjdoesjhappenjmorejfrequentl
yjinjpediatricjpatientsj(notj25-year-
olds)jandjmayjnotjbejassociatedjwithjMHjbutjyou'djnotjseejthejrisejinjHR,jBPjorjETCO
2jwithjit.
BerryjandjKohn'sjOperatingjRoomjTechniquej13thjedjChj31
Thej19-year-oldjpatientjarrivesjtojthejORjwithinj2jhoursjofjajtraumaticjopenjTib/
FibjfracturejforjORIF.jWhatjwoundjclassjisjit?
a.jClassjI
b.jClassjII
c.jClassjIII
d.jClassjIVj-jans-
AjfreshjopenjtraumajisjclassifiedjasjContaminatedj(Classj3),jAjfreshjtraumajisjonejthatj
isjlessjthanj4-6jhoursjoldjatjthejstartjofjsurgery.
Alexander'sjCarejofjthejPatientjinjSurgeryj16thjed.jCh
PatientsjwithjonejorjmorejofjVirchow'sjtriadjarejatjincreasedjriskjfor
Deepjveinjthrombosis
Hemorrhage
Surgicaljsitejinfection
Respiratoryjdistressj-jans-
Virchow'sjtriadjdescribesjthejthreejbroadjcategoriesjofjfactorsjthatjarejthoughtjtojcontri
Questions And Verified Answers
2025/2026
SmalljBoweljObstructionj(SBO)j-jans-
•Definition:jinabilityjofjthejboweljtojfunctionjeitherjfromjajmechanicaljproblemjorjajfuncti
onaljproblem
•Mechanicalj-outside:jadhesions
•Mechanicalj-inside:jtumor
•Functionalj-lack/slowjofjperistalsis
-AKAjparalyticjileus
Pathophysiologyj-jans-
•Gas,jtissue,jfecesjgatherjproximaljtojthejblockagej(jcouldjbejatjonejorjmorejsegmentsj
ofjbowel)jthisjgatheringjorjaccumulationjthenjdistendsjthejbowel.
•Swallowedjair,jfluidjfromjIVjspace,jgastricjjuices,jpancreaticjjuicesjbecomejstuckjinjthe
jGIjtract
•Increasedjgasjduejtojbacterialjaction/stasis
Increasedjintraluminaljpressurej-jans-
•Anyjincreasingjvolumejinjajclosedjspacejwithjdojthat!!!
•Lackjofjabsorptionjofjnutrientsjetc
•Edemajofjthejintestinaljwall,jthejincreasedjcapillaryjpermeability
•Upjtoj10jLjcanjmovejintojthejlumenjfromjthejIV/ISjspaces
Mechanical/strangulatedjherniaj-jans-•Largejamountsjofjischemiajinflammation/
necrosisjaffectjajportionjofjthejboweljandjcanjleadjtojperitonitis
•Peritonitis-
severejinfectionjofjthejnormallyjsterilejabdominaljcavityjthatjsurroundsjthejorgans
Severejcases:j-jans-•Thirdjspacingjisjsevere
•Distensionjisjsevere
•Fluidjvolumejdeficitjisjsevere
•SHOCKjpossiblejhere!!!
Functional/ileusj-jans-
•Etiology:jhandlingjofjboweljduringjsurgery,jsojpostjopjsomewhatjcommon
,•Blood,jmicroorgnaisms,jcanjalsojslowjthejperistalsisjwhenjtheyjcomejintojcontactjwithj
thejintestinejinjthejPjcavity
•Hypokalemia,juremia,jSCIs,jnarcotics
•Anticholinergics:jsometimesjinjclientsjinjthejpsychjfield
Signs/symptomsj-jans-Varyjdependingjonjleveljandjseverity/
completeness:jelectrolytejimablance
Crampy/colickyjabdominaljpain,jintermittentjorjcontinuous
Vomiting-especiallyjinjhigh,jcanjbecome
taste/
oderjofjfecesj(feculent)j(bacterialjfermentationjwithjstagnantjGIjcontents,jmorejcommon
jinjlowerjlevels)
Sj&Sjcontinuedj-jans-
•BelowjthejO,jthejboweljmayjemptyjearlyjon,jbutjlaterjtherejwilljbejnojstools/gas
•Borborygmi,jhighjpitchedjsounds
-Duejtojheroicjeffortjofjintestinejtojmovejthejobstruction....thisjisjearly
-Latej-boweljsoundsjarejabsent
Sj&jSofjajSBOj-jans-
•Observationjofjabdomenjbeforejpalpationjmayjshowjvisiblejwavesjofjmovementjacross
jthejthinjabdomen,jduejtojthejsmoothjmusclejtryingjveryjhardjtojmovejthejsegment/
Ojalong
•Distention:jminimaljwithjproximaljandjgreatjwithjdistal
•Tenderness
Latejsignsjmayjindicatejshockj-jans-
•Tachy,jlowjbloodjpressure,jTjelevation,joliguria,jtachypnea
•Hypovolemicjshockjduejthirdjspacingjandjvomitingjetc.
Complicationsj-jans-•Hypovolemiajandjshock
•MODS
•Renaljinsufficiency/failure/
•Atelectatis/pneumonia
•Peritonitis/gangrene/perforation/septicjshock
•Mortalityjreatej10%jinjSBO
•Withjstrangulation:jupjtoj20-75%
Diagnosticsj-jans-•WBC
•Serumjamylase
•Serumjosmolality/lytes
•ABGs
•Abdominaljflatjplate
•CTjwithjcontrastjmedia:jcheckjiodinejallergies
•Bariumjenema/jsigmoidoscopy/colonoscopy
,Medicaljtreatment/conservativej-jans-•GIjdecompressionjwithjNGjtubes
•Boweljrest
•ProkineticjAgents-REglan?
jForjputtingjtubejdownjifjpyloricjvalvejdoesjnotjcooperate,jcisapridej(Propulsid?)
•Anti-emetics-
TreatmentjAggressivejSurgicalj-jans-
•Requiredjforjcompletejmechanicaljandjforjstrangulated/incarcerated
•Laporotomy
•Removejadhesions
•Tumorjresection
•Boweljresectionjforjgangrenousjsegments
•Anastomosis
NursingjDiagnosisj-jans-•FVDjr/tjsequestrationjofjfluidjinjboweljandjvomiting
•Ineffectivejtissuejperfusion:jGIjr/tjpossiblejstrangulation/distention
•Ineffectivejbreathingjpatternjr/tjabdominaljdistention
Outcomesj-jans-•Fluidjbalance
•Effectivejventilation/breathing
•EffectivejTissuejperfusion:GI
•Painjcontrol
•Balancedjnutrition
•Wound/incisionjHealed:jprimary/secondary
Interventionsj-jans-•Analgesics/PCA
•Fluidjmanagement
•Nutritionjmonitoring
•Positioning
•Respiratoryjmonitoring/splinting
•Incisionjcare/woundjcare
HealthjPromotion:jPrimaryj-jans-•Dietaryjintake:jfiber,jfluid,
•Exercise
•AvoidjpopcornjifjvulnerablejtojseveraljSBOs
HealthjPromotion:Secondaryj-jans-
•Earlyjseekingjofjmedicaljassistancejforjabdominaljpain,jnausea,jvomiting,
•AbjWhatjWoundjclassificationjforjvaginaljhysterectomy?
a.jClassjI
b.jClassjII
c.jClassjIII
d.jClassjIVj-jans-B.jTherejisjcontrolledjentryjintojthejgenitourinaryjtract.
, Alexander'sjCarejofjthejPatientjinjSurgeryj16thjed.jChj9
ThejCRNAjisjattemptingjtojopenjthej25-year-
oldjman'sjmouthjforjintubationjbutjthejjawjisjtightjandjshe'sjhavingjdifficulty.jthejnursejn
oticesjthatjthejpatient'sjcapnographjisjrisingjdramaticallyjasjthejCRNAjcontinuesjtojstru
gglejtojopenjthejjawjtojintubatejandjthejpatient'sjheartjratejandjbloodjpressurejarejrisin
g.jwhatjisjthejappropriatejresponsejforjthejperioperativejnurse?
a.jThejanesthesiajisjtoojlight,jandjthejpatientjisjconfusedjandjstrugglingjagainstjthejCR
NAjthejperioperativejnursejsuggestsjgivingjmorejsedation
b.jThesejarejsignsjofjmalignantjhypothermiajthejperioperativejnursejtellsjthejCRNAjwh
atjshe'sjseeing.jthejperioperativejnursejcallsjthejorjdeskjtojaskjforjhelpjandjthejMHjcart
jbejbroughtjtojthejroom.
c.jthejpatientjisjhavingjanjallergicjreactionjtojajmedication.jthejperioperativejnursejinfor
msjanesthesiajproviderjandjassistsjaccordingly
d.jMASSETEERjspacejmusclejrigidityjalsojknownjasjMMRjisjnotjunj-jans-
B.jThesejarejearlyjsignsjofjMalignantjHyperthermia.jMMRjdoesjhappenjmorejfrequentl
yjinjpediatricjpatientsj(notj25-year-
olds)jandjmayjnotjbejassociatedjwithjMHjbutjyou'djnotjseejthejrisejinjHR,jBPjorjETCO
2jwithjit.
BerryjandjKohn'sjOperatingjRoomjTechniquej13thjedjChj31
Thej19-year-oldjpatientjarrivesjtojthejORjwithinj2jhoursjofjajtraumaticjopenjTib/
FibjfracturejforjORIF.jWhatjwoundjclassjisjit?
a.jClassjI
b.jClassjII
c.jClassjIII
d.jClassjIVj-jans-
AjfreshjopenjtraumajisjclassifiedjasjContaminatedj(Classj3),jAjfreshjtraumajisjonejthatj
isjlessjthanj4-6jhoursjoldjatjthejstartjofjsurgery.
Alexander'sjCarejofjthejPatientjinjSurgeryj16thjed.jCh
PatientsjwithjonejorjmorejofjVirchow'sjtriadjarejatjincreasedjriskjfor
Deepjveinjthrombosis
Hemorrhage
Surgicaljsitejinfection
Respiratoryjdistressj-jans-
Virchow'sjtriadjdescribesjthejthreejbroadjcategoriesjofjfactorsjthatjarejthoughtjtojcontri
