MED-SURG. EXAM 1 2025 WITH CORRECT ANSWERS.

MED-SURG. EXAM 1 2025 WITH
CORRECT ANSWERS




Because of an unexpected emergency case, a client scheduled for colon surgery at 8 am has been rescheduled
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for 11 am. What is the nurse's best action related to preoperative prophylactic antibiotic administration
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according to the Surgical Care Improvement Project (SCIP) guidelines?
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A Administer the preoperative antibiotic at 7 am as originally prescribed.
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B Administer the antibiotic at the same time as the other prescribed preoperative drugs.
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C Adjust the antibiotic administration time to be within 1 hour before the surgical incision.
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D Hold the preoperative antibiotic until the client is actually in the operating room and has been anesthetized.
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- correct answer C - The goal of prophylaxis is to establish bactericidal tissue and serum levels at the time of
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skin incision. The SCIP recommendations are that the antibiotic be administered 1 hour before the actual
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surgical incision. Giving the drug at 7 AM seriously interferes with maintaining the blood (serum) level at the
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proper level when the surgery is actually taking place. Administering the antibiotic with the other
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preoperative drugs may or may not be within the recommended time frame. Waiting until the client is e e e e e e e e e e e e e e e e e




anesthetized is too late for best antibiotic action and peak serum levels. e e e e e e e e e e e




What will withdrawal of alcohol before surgery lead to? - correct answer Delirium Tremens
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An 81-year-old client, scheduled for a long orthopedic procedure, appears to have a low body mass index. In
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addition to the body mass index value, which additional client information is most important for the nurse to
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report to the surgeon and perioperative team as indicating an increased risk for skin breakdown?
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A Negative nitrogen balance
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B Previous abdominal surgery
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,C Allergy to latex products
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D Change in mental status upon admission - correct answer A - A negative nitrogen balance can be a sign of
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inadequate protein intake and malnutrition, resulting in a low BMI. These factors contribute to skin e e e e e e e e e e e e e e e




breakdown. Although the change in mental status can increase the risk for skin breakdown after surgery if the e e e e e e e e e e e e e e e e e e




client is not aware of the need to change position, it is not the most critical risk factor at this time. The allergy to
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latex products is critical information to communicate to the perioperative team but does not contribute to
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skin breakdown. e




The preoperative admitting nurse notices that the client scheduled for total joint replacement surgery in 2
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hours has a smell of alcohol on his breath even though he has just stated that he has fasted completely for the
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past 10 hours. What is the nurse's best first action?
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A Accept the client's statement and continue the preoperative preparation.
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B Report the discrepancy to the surgeon and anesthesiologist immediately.
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C Tell the client the observation and provide the opportunity for him to explain.
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D Remind the client that alcohol consumption may require changes in anesthesia procedure. - correct answer
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C - Although alcohol consumption before a surgical procedure with anesthesia can cause serious problems,
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the nurse should not "jump to conclusions" with his or her observations. Before informing the surgeon and
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anesthesiologist, the nurse should provide the client with the opportunity to explain the alcohol smell on his e e e e e e e e e e e e e e e e e




breath. Some mouthwashes contain chemicals and alcohol that could leave a perceptible odor. Also, the
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nurse could be mistaken about the odor. e e e e e e




The patient states the surgeon discussed the addition of a second procedure to the one indicated on the
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consent. The patient is visibly upset that the consent he is asked to sign with the surgical resident reflects only
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one procedure and cannot understand why the nurse and resident do not have the authority to "fix" the
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consent. In addition, he states he will not take his wedding ring off because it has never left his hand since his
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wife put it there 30 years ago. e e e e e e e




1. How would you address the patient's immediate concern regarding the consent?
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2. Under what conditions could the second procedure be performed?
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3. What remedy would you propose to prevent such occurrences in the future?
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4. How will you respond to the patient's unwillingness to remove his wedding ring? - correct answer 1. How
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would you address the patient's immediate concern regarding the consent?
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Focus your answer on the safety aspect of the situation while acknowledging the patient's frustration. Inform
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the patient that you will contact the surgeon to clarify the consent in terms of accuracy and that neither you
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nor the surgical resident not have the authority to alter the consent without the surgeon's knowledge.
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Document it in the medical record. e e e e e

,2. Under what conditions could the second procedure be performed?
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The second procedure could be performed if a new consent is developed with both procedures listed and
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signed by the patient. This new consent can only be used if the patient is not under the influence of
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preoperative drugs that could cloud his judgment and if the patient has received adequate information e e e e e e e e e e e e e e e




regarding both procedures to be able to make an informed choice. e e e e e e e e e e




3. What remedy would you propose to prevent such occurrences in the future?
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Discuss the occurrence with the perioperative team, review existing policy, and make changes as needed.
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Propose a process for facilitating communication among departments and team members.
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4. How will you respond to the patient's unwillingness to remove his wedding ring?
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Explain to him that removal of the ring is not necessary if the finger is not the operative site. Tape the ring in
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place if agency policy permits. If the agency does not permit this action, explain why and have his wife keep the
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ring with her until she sees him after surgery.
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Colostomy surgery is categorized as what type of surgery? e e e e e e e e




e Cosmetic

e Curative

e Diagnostic

Palliative - correct answer Pallative - Palliative surgery is performed to relieve symptoms of a disease process,
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but does not cure the disease. Cosmetic surgery is performed primarily to alter or enhance personal
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appearance. Curative surgery is performed to resolve a health problem by repairing or removing the cause. e e e e e e e e e e e e e e e e




Diagnostic surgery is performed to determine the origin and cause of a disorder or the cell type for cancer.
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In going through the preoperative checklist, the nurse notices that the client's armband does not match the
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handwritten name on the informed consent, but it matches the stamped name. What does the nurse do first? e e e e e e e e e e e e e e e e e




e Call admissions. e




e Cancel the surgery. e e




e Contact the surgeon. e e




Talk to the operating team. - correct answer Talk to the operating team - The operating team should be called
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to see if any clients with similar names are having surgery done. The client should confirm the spelling of his or
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her last name. Also, confirm the procedure that is expected to be done and compare it with the informed
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consent form. Calling admissions is not the first step; the stamp is correct. Canceling surgery is not done by the
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floor nurse. This is an administrative issue, and not one for the surgeon.
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, As the nurse obtains the informed consent, the client asks, "Now what exactly are they going to do to me?"
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What is the nurse's response? e e e e




e Contact the anesthesiologist. e e




e Contact the surgeon. e e




e Explain the procedure. e e




Have the client sign the form. - correct answer Contact the surgeon - The nurse is not responsible for providing
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detailed information about the surgical procedure. Rather, the nurse's role is to clarify facts that have been
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presented by the health care provider and dispel myths that the client or family may have heard about thee e e e e e e e e e e e e e e e e e e




surgical experience. The anesthesiologist is responsible for the anesthesia, not the surgical details. Although
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the nurse is only witnessing the signature, it is the nurse's role to ensure that the facts are clarified before the
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consent form is signed. e e e




The nurse is educating a client who is about to undergo cardiac surgery with general anesthesia. Which
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statement by the client indicates the need for further instruction? e e e e e e e e e




e "I will wake up with a tube in my throat."
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e "I will have a bandage on my chest."
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e "My family will not be able to see me right away."
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"Pain medication will take away my pain." - correct answer "Pain medication.." - Pain medication will
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minimize pain, but will not take it away completely. The client statement about waking up with a tube in the
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throat is accurate, because the client will be intubated. Following heart surgery, a dressing is placed on the
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chest. The client will not be able to see family immediately because he or she will go to recovery first
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An older client's adult child tells the nurse that the client does not want life support. What does the nurse do
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first?

e Call the legal department to draft the paperwork.
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e Document this in the chart. e e e e




e Thank the person and do nothing else. e e e e e e




Talk to the client. - correct answer Talk to the client - The nurse should determine the client's wishes and state
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of mind. The nurse should not call the legal department or document in the client's chart before speaking with
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the client. Doing nothing is not appropriate.
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A preoperative client smokes a pack of cigarettes a day. What is the nurse's teaching priority for the best
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physical outcomes? e