, CHAPTER LIST
Part 1: The Surgical Nurse & the Nature of Surgical Nursing
Chapter 1: The Role of the Surgical Nurse and Knowledge for Practice
Chapter 2: The Surgical Nurse as an Independent & Collaborative Practitioner
Chapter 3: The Surgical Nurse as Teacher & Health Promoter
Chapter 4: Ethical & Legal Aspects of Nursing Surgical Patients
Chapter 5: Support for the Surgical Nurse & Supporting Others
Chapter 6: Clinical Career Structure & Opportunities for Nurses Caring for Surgical Patients
Part 2: The Person Undergoing Surgery
Chapter 7: The Person as a Holistic Being
Chapter 8: Physiological Implications of Surgery
Chapter 9: Psychological Implications of Surgery
Chapter 10: Socio-Cultural Implications of Surgery
Chapter 11: The Patient/Client at Different Life Stages in the Surgical Setting
Part 3: The Environment for Surgery
Chapter 12: The Changing Setting for Surgery
Chapter 13: Principles of Infection Control & the Hospital Environment
Chapter 14: The Pre-Admission Clinic
Chapter 15: The High-Dependency Unit
Chapter 16: The Health Centre Environment
Part 4: Health Outcomes of Surgery
Chapter 17: Health Outcomes of Surgery
Chapter 18: Clinical Indicators & Outcomes in Surgery
Part 5: Key Concepts When Caring for Patients Undergoing Surgery
Chapter 19: Principles of Preparing Patients/Clients for Surgery
Chapter 20: Principles of Intra-Operative Care
Chapter 21: Principles of Post-Operative Care
Chapter 22: Maintaining Effective Breathing
Chapter 23: Pain Control
Chapter 24: Managing Nausea & Vomiting
Chapter 25: Maintaining Adequate Circulation
Chapter 26: Fluid & Electrolyte Balance
Chapter 27: Maintaining Optimum Nutrition
Chapter 28: Wound Drainage, Healing & Management
,Chapter 1: The Role of the Surgical Nurse and
Knowledge for Practice
NCLEX-Style Single-Answer Multiple Choice (Questions 1–10)
1. A surgical nurse is completing a preoperative assessment for a patient scheduled for an
elective laparoscopic cholecystectomy. Which action best reflects the nurse working within the
defined scope of surgical nursing practice rather than the surgeon's domain?
A. Specifying the intraoperative energy devices and trocars to be utilized during surgery.
B. Deciding whether to convert the laparoscopic approach to an open procedure.
C. Assessing the patient's anxiety level, physical readiness, and baseline physiological
parameters.
D. Explaining the operative risks, benefits, and surgical alternatives to obtain consent.
Answer: C
Rationale: The surgical nurse's independent domain includes holistic assessment of patient
readiness, anxiety, baseline vital signs, and nursing care planning across the perioperative
continuum. Explaining operative risks/benefits (D) and determining operative techniques or
equipment (B, A) are direct responsibilities of the operating surgeon.
2. A nurse with two years of surgical ward experience is managing a complex post-colectomy
patient. The nurse demonstrates deliberate, goal-directed care planning and prioritizes patient
interventions based on clinical urgency. According to Benner's Novice-to-Expert model, at which
stage of clinical competence is this nurse operating?
A. Competent
B. Advanced Beginner
C. Novice
D. Expert
,Answer: A
Rationale: According to Patricia Benner's model, a "Competent" practitioner typically has 2 to 3
years of clinical experience on the same unit and demonstrates conscious, deliberate, and
organized care planning with a clear sense of priority. Novices rely strictly on rules, advanced
beginners recognize meaningful components of real situations, and experts possess an intuitive
grasp without reliance on analytical rules.
3. During a clinical audit, a surgical nurse explains that the physiological rationale for early
postoperative mobilization is grounded in research demonstrating increased venous return and
reduced deep vein thrombosis risk. Which type of knowledge is the nurse primarily utilizing?
A. Personal knowledge
B. Propositional knowledge
C. Experiential knowledge
D. Aesthetic knowledge
Answer: B
Rationale: Propositional knowledge (empirical or theoretical knowledge) consists of research
evidence, theories, scientific facts, and formal concepts derived from study. Experiential
knowledge comes from practical experience, personal knowledge relates to self-awareness and
empathy, and aesthetic knowledge relates to the art of nursing care.
4. The concept of the "knowledgeable doer" in surgical nursing practice is best demonstrated by
which clinical behavior?
A. Performing technical psychomotor skills rapidly while delegating patient evaluation.
B. Following established ward protocols without questioning their theoretical basis.
C. Combining sound scientific principles with reflective practice to adapt care dynamically.
D. Referring all complex clinical decision-making exclusively to the surgical registrar.
Answer: C
Rationale: The "knowledgeable doer" is an autonomous practitioner who synthesizes
theoretical knowledge, critical reflection, evidence-based principles, and practical skill to deliver
safe, individualized care rather than passively executing routine tasks or mindlessly following
rules.
,5. An experienced surgical nurse observes subtle facial grimacing and slight tachypnea in a
patient following gastric surgery, immediately suspecting early internal hemorrhage before overt
vital sign changes occur. What level of practice according to Benner characterizes this intuitive
clinical grasp?
A. Proficient
B. Advanced Beginner
C. Expert
D. Competent
Answer: C
Rationale: The "Expert" nurse operates with an intuitive grasp of clinical situations based on
vast background experience, recognizing subtle pattern changes without needing to analyze
formal steps or guidelines. Proficient nurses view situations holistically but still utilize analytical
reasoning for decision-making.
6. A surgical nurse reviews recent clinical trial evidence regarding negative-pressure wound
therapy versus standard dressings for closed laparotomy incisions. When applying evidence-
based practice (EBP) principles, what additional element must the nurse integrate alongside
research evidence?
A. Cost-saving directives imposed by ward management
B. Personal ward traditions and historical habit
C. Unilateral physician preference without consultation
D. Clinical expertise and patient values/preferences
Answer: D
Rationale: Evidence-based practice in nursing is defined as the integration of the best available
research evidence with clinical expertise and patient values/preferences within the context of
caring environment. Ward tradition or management directives alone do not constitute EBP.
7. A surgical nurse reflects on a difficult central line dressing change performed earlier in the
shift to refine psychomotor technique for future encounters. Which form of knowledge
development is occurring?
A. Theoretical deduction
,B. Reflection-in-action and experiential knowledge
C. Ethical knowing
D. Propositional learning
Answer: B
Rationale: Practical and experiential knowledge is developed through direct hands-on practice
combined with reflection-on-action (and reflection-in-action), allowing practitioners to refine
clinical skills and internalize practical wisdom ("know-how").
8. During the intraoperative phase, which responsibility falls squarely within the surgical nurse's
professional domain as a patient advocate?
A. Performing primary surgical vessel ligation and tissue resections.
B. Signing the operative consent form on behalf of the attending surgeon.
C. Ensuring strict adherence to the WHO Surgical Safety Checklist and sterile boundary
maintenance.
D. Administering general anesthetic agents and endotracheal intubation.
Answer: C
Rationale: In the intraoperative phase, the scrub and circulating nurses serve as vital patient
advocates by enforcing aseptic technique, completing safety checks (WHO checklist),
maintaining instrument counts, and ensuring patient safety. Anesthesia administration and
primary surgical resections belong to anesthetists and surgeons, respectively.
9. A surgical nurse takes time to sit with a patient who expresses profound fear of disfigurement
before a total laryngectomy, actively listening and validating the patient's emotional distress.
According to Carper's patterns of knowing, which pattern is showcased?
A. Ethics
B. Personal knowing
C. Empirics
D. Aesthetics
Answer: B
Rationale: Personal knowing refers to the nurse's self-awareness, therapeutic use of self, and
,authentic interpersonal engagement with the patient as a unique human being. Empirics deals
with science, ethics with moral duties, and aesthetics with the art of nursing care transformation.
10. A newly qualified nurse on a vascular surgical unit is assigned to care for a patient post-
femoropopliteal bypass. The nurse follows the unit protocol step-by-step but struggles when the
patient's presentation slightly deviates from the written protocol. Which stage of Benner's model
does this represent?
A. Proficient
B. Novice / Advanced Beginner
C. Expert
D. Competent
Answer: B
Rationale: Novices and Advanced Beginners rely heavily on context-free rules, standardized
protocols, and explicit guidelines. When clinical situations deviate from standard rules, beginner
nurses experience difficulty because they lack the background clinical experience to adapt rules
fluidly.
Select-All-That-Apply (SATA) (Questions 11–16)
11. Which statements accurately describe the progression of clinical practice across Benner's
Novice-to-Expert continuum in surgical nursing? Select all that apply.
A. Movement occurs from reliance on abstract principles to the use of past concrete
experiences.
B. The learner shifts from viewing situations as discrete parts to viewing them as complete
wholes.
C. The nurse transitions from an active participant to a detached observer as expertise
increases.
D. Performance changes from rule-governed behavior to fluid, intuitive clinical reasoning.
E. Expert nurses no longer require continuing professional development or reflective practice.
F. Clinical judgment becomes increasingly contextualized and tailored to individual patient
responses.
,Answer: A, B, D, F
Rationale: Benner's continuum outlines key transitions: movement from abstract
principles/rules to concrete experiences (A), shifting from seeing fragmented parts to holistic
wholes (B), moving from rule-bound behavior to intuitive practice (D), and contextualizing
judgment (F). Option C is incorrect because expertise increases engagement, not detachment.
Option E is false because lifelong learning is required at all levels.
12. A surgical nurse acting as a "knowledgeable doer" is preparing a patient for emergency
abdominal surgery. Which actions embody this practice framework? Select all that apply.
A. Verifying physiological baseline values and correlating them with underlying pathology.
B. Questioning an unclear or inappropriate drug order with the prescribing doctor.
C. Performing tasks automatically without explaining procedures to the patient.
D. Integrating current evidence-based infection control standards during catheter insertion.
E. Reflecting on clinical outcomes to improve future perioperative care delivery.
Answer: A, B, D, E
Rationale: A knowledgeable doer combines critical analysis, scientific rationale, patient
advocacy, safety protocols, and reflective learning (A, B, D, E). Performing tasks mindlessly or
automatically without communication (C) is antithetical to knowledgeable doing.
13. According to Barbara Carper's Fundamental Patterns of Knowing, which dimensions must a
surgical nurse integrate to deliver holistic patient care? Select all that apply.
A. Empirical knowing (the science of nursing)
B. Aesthetic knowing (the art of nursing)
C. Personal knowing (therapeutic use of self)
D. Ethical knowing (moral knowledge and values)
E. Financial knowing (cost-minimization strategy)
F. Institutional knowing (politicized organizational hierarchy)
Answer: A, B, C, D
Rationale: Carper (1978) identified four fundamental patterns of knowing in nursing: Empirics,
Aesthetics, Personal knowing, and Ethics. Financial and institutional metrics are administrative
considerations, not part of Carper's core taxonomy.
,14. The surgical nurse is managing a patient in the immediate postoperative recovery period.
Which nursing interventions reflect the nurse's independent professional scope? Select all that
apply.
A. Assessing airway patency and respiratory effort.
B. Prescribing prescription-only intravenous opioids.
C. Inspecting the surgical dressing for active hemorrhage.
D. Determining the surgical incision placement and closure technique.
E. Positioning the patient to promote optimal lung expansion.
F. Evaluating postoperative pain using a validated numerical rating scale.
Answer: A, C, E, F
Rationale: Independent nursing actions include airway assessment, surgical site inspection,
positioning for oxygenation, and pain assessment (A, C, E, F). Prescribing prescription-only
medicines (B, unless an advanced independent nurse prescriber) and deciding surgical incision
details (D) belong to medical/surgical scope.
15. Which factors act as significant facilitators for embedding Evidence-Based Practice (EBP)
within a surgical hospital ward? Select all that apply.
A. Access to online health databases and electronic library resources.
B. Ward leadership that supports clinical inquiry and reflective practice.
C. Strict insistence on following historical ward traditions without questioning.
D. Protected time for staff nurses to engage in journal clubs and guidelines review.
E. High patient-to-nurse staffing ratios that minimize shift duration.
F. Availability of clinical nurse specialists to mentor ward staff in research critique.
Answer: A, B, D, F
Rationale: Facilitators of EBP include access to research databases, supportive leadership,
protected time for appraisal, and mentorship by clinical experts (A, B, D, F). Traditionalism (C)
and poor staffing ratios/workload barriers hinder EBP.
16. Which nursing activities demonstrate effective patient advocacy during the perioperative
journey? Select all that apply.
A. Verifying that the surgical consent form was completed voluntarily without coercion.
, B. Halting a procedure during the WHO "Time Out" if a discrepancy in site marking exists.
C. Proceeding with surgery when a patient expresses unaddressed doubts about consent.
D. Ensuring the patient's bodily privacy and dignity are maintained in theatre.
E. Encouraging a patient to voice concerns regarding postoperative pain management.
Answer: A, B, D, E
Rationale: Advocacy involves verifying voluntary consent, stopping procedures for safety
concerns during WHO checks, protecting dignity/privacy, and empowering patient
communication (A, B, D, E). Ignoring patient doubts regarding consent (C) violates patient
advocacy.
Prioritization / Ordered Response (Questions 17–20)
17. Arrange the stages of Patricia Benner's Novice-to-Expert model in correct sequential order
from initial entry into practice to the highest level of mastery.
A. Novice
B. Proficient
C. Competent
D. Advanced Beginner
E. Expert
Answer: A, D, C, B, E
Rationale: Benner's model follows five progressive stages: Novice (A), Advanced Beginner (D),
Competent (C), Proficient (B), and Expert (E).
18. A surgical nurse receives a patient returning to the surgical ward from the Post-Anesthesia
Care Unit (PACU) following major bowel resection. Place the nurse's assessment priorities in
correct sequential order according to clinical urgency.
A. Assess airway patency, respiratory rate, and oxygen saturation.
B. Check blood pressure, heart rate, peripheral perfusion, and cardiac rhythm.
C. Evaluate pain score, level of sedation, and comfort measures.
D. Inspect the surgical abdominal dressing and wound drain outputs.
Part 1: The Surgical Nurse & the Nature of Surgical Nursing
Chapter 1: The Role of the Surgical Nurse and Knowledge for Practice
Chapter 2: The Surgical Nurse as an Independent & Collaborative Practitioner
Chapter 3: The Surgical Nurse as Teacher & Health Promoter
Chapter 4: Ethical & Legal Aspects of Nursing Surgical Patients
Chapter 5: Support for the Surgical Nurse & Supporting Others
Chapter 6: Clinical Career Structure & Opportunities for Nurses Caring for Surgical Patients
Part 2: The Person Undergoing Surgery
Chapter 7: The Person as a Holistic Being
Chapter 8: Physiological Implications of Surgery
Chapter 9: Psychological Implications of Surgery
Chapter 10: Socio-Cultural Implications of Surgery
Chapter 11: The Patient/Client at Different Life Stages in the Surgical Setting
Part 3: The Environment for Surgery
Chapter 12: The Changing Setting for Surgery
Chapter 13: Principles of Infection Control & the Hospital Environment
Chapter 14: The Pre-Admission Clinic
Chapter 15: The High-Dependency Unit
Chapter 16: The Health Centre Environment
Part 4: Health Outcomes of Surgery
Chapter 17: Health Outcomes of Surgery
Chapter 18: Clinical Indicators & Outcomes in Surgery
Part 5: Key Concepts When Caring for Patients Undergoing Surgery
Chapter 19: Principles of Preparing Patients/Clients for Surgery
Chapter 20: Principles of Intra-Operative Care
Chapter 21: Principles of Post-Operative Care
Chapter 22: Maintaining Effective Breathing
Chapter 23: Pain Control
Chapter 24: Managing Nausea & Vomiting
Chapter 25: Maintaining Adequate Circulation
Chapter 26: Fluid & Electrolyte Balance
Chapter 27: Maintaining Optimum Nutrition
Chapter 28: Wound Drainage, Healing & Management
,Chapter 1: The Role of the Surgical Nurse and
Knowledge for Practice
NCLEX-Style Single-Answer Multiple Choice (Questions 1–10)
1. A surgical nurse is completing a preoperative assessment for a patient scheduled for an
elective laparoscopic cholecystectomy. Which action best reflects the nurse working within the
defined scope of surgical nursing practice rather than the surgeon's domain?
A. Specifying the intraoperative energy devices and trocars to be utilized during surgery.
B. Deciding whether to convert the laparoscopic approach to an open procedure.
C. Assessing the patient's anxiety level, physical readiness, and baseline physiological
parameters.
D. Explaining the operative risks, benefits, and surgical alternatives to obtain consent.
Answer: C
Rationale: The surgical nurse's independent domain includes holistic assessment of patient
readiness, anxiety, baseline vital signs, and nursing care planning across the perioperative
continuum. Explaining operative risks/benefits (D) and determining operative techniques or
equipment (B, A) are direct responsibilities of the operating surgeon.
2. A nurse with two years of surgical ward experience is managing a complex post-colectomy
patient. The nurse demonstrates deliberate, goal-directed care planning and prioritizes patient
interventions based on clinical urgency. According to Benner's Novice-to-Expert model, at which
stage of clinical competence is this nurse operating?
A. Competent
B. Advanced Beginner
C. Novice
D. Expert
,Answer: A
Rationale: According to Patricia Benner's model, a "Competent" practitioner typically has 2 to 3
years of clinical experience on the same unit and demonstrates conscious, deliberate, and
organized care planning with a clear sense of priority. Novices rely strictly on rules, advanced
beginners recognize meaningful components of real situations, and experts possess an intuitive
grasp without reliance on analytical rules.
3. During a clinical audit, a surgical nurse explains that the physiological rationale for early
postoperative mobilization is grounded in research demonstrating increased venous return and
reduced deep vein thrombosis risk. Which type of knowledge is the nurse primarily utilizing?
A. Personal knowledge
B. Propositional knowledge
C. Experiential knowledge
D. Aesthetic knowledge
Answer: B
Rationale: Propositional knowledge (empirical or theoretical knowledge) consists of research
evidence, theories, scientific facts, and formal concepts derived from study. Experiential
knowledge comes from practical experience, personal knowledge relates to self-awareness and
empathy, and aesthetic knowledge relates to the art of nursing care.
4. The concept of the "knowledgeable doer" in surgical nursing practice is best demonstrated by
which clinical behavior?
A. Performing technical psychomotor skills rapidly while delegating patient evaluation.
B. Following established ward protocols without questioning their theoretical basis.
C. Combining sound scientific principles with reflective practice to adapt care dynamically.
D. Referring all complex clinical decision-making exclusively to the surgical registrar.
Answer: C
Rationale: The "knowledgeable doer" is an autonomous practitioner who synthesizes
theoretical knowledge, critical reflection, evidence-based principles, and practical skill to deliver
safe, individualized care rather than passively executing routine tasks or mindlessly following
rules.
,5. An experienced surgical nurse observes subtle facial grimacing and slight tachypnea in a
patient following gastric surgery, immediately suspecting early internal hemorrhage before overt
vital sign changes occur. What level of practice according to Benner characterizes this intuitive
clinical grasp?
A. Proficient
B. Advanced Beginner
C. Expert
D. Competent
Answer: C
Rationale: The "Expert" nurse operates with an intuitive grasp of clinical situations based on
vast background experience, recognizing subtle pattern changes without needing to analyze
formal steps or guidelines. Proficient nurses view situations holistically but still utilize analytical
reasoning for decision-making.
6. A surgical nurse reviews recent clinical trial evidence regarding negative-pressure wound
therapy versus standard dressings for closed laparotomy incisions. When applying evidence-
based practice (EBP) principles, what additional element must the nurse integrate alongside
research evidence?
A. Cost-saving directives imposed by ward management
B. Personal ward traditions and historical habit
C. Unilateral physician preference without consultation
D. Clinical expertise and patient values/preferences
Answer: D
Rationale: Evidence-based practice in nursing is defined as the integration of the best available
research evidence with clinical expertise and patient values/preferences within the context of
caring environment. Ward tradition or management directives alone do not constitute EBP.
7. A surgical nurse reflects on a difficult central line dressing change performed earlier in the
shift to refine psychomotor technique for future encounters. Which form of knowledge
development is occurring?
A. Theoretical deduction
,B. Reflection-in-action and experiential knowledge
C. Ethical knowing
D. Propositional learning
Answer: B
Rationale: Practical and experiential knowledge is developed through direct hands-on practice
combined with reflection-on-action (and reflection-in-action), allowing practitioners to refine
clinical skills and internalize practical wisdom ("know-how").
8. During the intraoperative phase, which responsibility falls squarely within the surgical nurse's
professional domain as a patient advocate?
A. Performing primary surgical vessel ligation and tissue resections.
B. Signing the operative consent form on behalf of the attending surgeon.
C. Ensuring strict adherence to the WHO Surgical Safety Checklist and sterile boundary
maintenance.
D. Administering general anesthetic agents and endotracheal intubation.
Answer: C
Rationale: In the intraoperative phase, the scrub and circulating nurses serve as vital patient
advocates by enforcing aseptic technique, completing safety checks (WHO checklist),
maintaining instrument counts, and ensuring patient safety. Anesthesia administration and
primary surgical resections belong to anesthetists and surgeons, respectively.
9. A surgical nurse takes time to sit with a patient who expresses profound fear of disfigurement
before a total laryngectomy, actively listening and validating the patient's emotional distress.
According to Carper's patterns of knowing, which pattern is showcased?
A. Ethics
B. Personal knowing
C. Empirics
D. Aesthetics
Answer: B
Rationale: Personal knowing refers to the nurse's self-awareness, therapeutic use of self, and
,authentic interpersonal engagement with the patient as a unique human being. Empirics deals
with science, ethics with moral duties, and aesthetics with the art of nursing care transformation.
10. A newly qualified nurse on a vascular surgical unit is assigned to care for a patient post-
femoropopliteal bypass. The nurse follows the unit protocol step-by-step but struggles when the
patient's presentation slightly deviates from the written protocol. Which stage of Benner's model
does this represent?
A. Proficient
B. Novice / Advanced Beginner
C. Expert
D. Competent
Answer: B
Rationale: Novices and Advanced Beginners rely heavily on context-free rules, standardized
protocols, and explicit guidelines. When clinical situations deviate from standard rules, beginner
nurses experience difficulty because they lack the background clinical experience to adapt rules
fluidly.
Select-All-That-Apply (SATA) (Questions 11–16)
11. Which statements accurately describe the progression of clinical practice across Benner's
Novice-to-Expert continuum in surgical nursing? Select all that apply.
A. Movement occurs from reliance on abstract principles to the use of past concrete
experiences.
B. The learner shifts from viewing situations as discrete parts to viewing them as complete
wholes.
C. The nurse transitions from an active participant to a detached observer as expertise
increases.
D. Performance changes from rule-governed behavior to fluid, intuitive clinical reasoning.
E. Expert nurses no longer require continuing professional development or reflective practice.
F. Clinical judgment becomes increasingly contextualized and tailored to individual patient
responses.
,Answer: A, B, D, F
Rationale: Benner's continuum outlines key transitions: movement from abstract
principles/rules to concrete experiences (A), shifting from seeing fragmented parts to holistic
wholes (B), moving from rule-bound behavior to intuitive practice (D), and contextualizing
judgment (F). Option C is incorrect because expertise increases engagement, not detachment.
Option E is false because lifelong learning is required at all levels.
12. A surgical nurse acting as a "knowledgeable doer" is preparing a patient for emergency
abdominal surgery. Which actions embody this practice framework? Select all that apply.
A. Verifying physiological baseline values and correlating them with underlying pathology.
B. Questioning an unclear or inappropriate drug order with the prescribing doctor.
C. Performing tasks automatically without explaining procedures to the patient.
D. Integrating current evidence-based infection control standards during catheter insertion.
E. Reflecting on clinical outcomes to improve future perioperative care delivery.
Answer: A, B, D, E
Rationale: A knowledgeable doer combines critical analysis, scientific rationale, patient
advocacy, safety protocols, and reflective learning (A, B, D, E). Performing tasks mindlessly or
automatically without communication (C) is antithetical to knowledgeable doing.
13. According to Barbara Carper's Fundamental Patterns of Knowing, which dimensions must a
surgical nurse integrate to deliver holistic patient care? Select all that apply.
A. Empirical knowing (the science of nursing)
B. Aesthetic knowing (the art of nursing)
C. Personal knowing (therapeutic use of self)
D. Ethical knowing (moral knowledge and values)
E. Financial knowing (cost-minimization strategy)
F. Institutional knowing (politicized organizational hierarchy)
Answer: A, B, C, D
Rationale: Carper (1978) identified four fundamental patterns of knowing in nursing: Empirics,
Aesthetics, Personal knowing, and Ethics. Financial and institutional metrics are administrative
considerations, not part of Carper's core taxonomy.
,14. The surgical nurse is managing a patient in the immediate postoperative recovery period.
Which nursing interventions reflect the nurse's independent professional scope? Select all that
apply.
A. Assessing airway patency and respiratory effort.
B. Prescribing prescription-only intravenous opioids.
C. Inspecting the surgical dressing for active hemorrhage.
D. Determining the surgical incision placement and closure technique.
E. Positioning the patient to promote optimal lung expansion.
F. Evaluating postoperative pain using a validated numerical rating scale.
Answer: A, C, E, F
Rationale: Independent nursing actions include airway assessment, surgical site inspection,
positioning for oxygenation, and pain assessment (A, C, E, F). Prescribing prescription-only
medicines (B, unless an advanced independent nurse prescriber) and deciding surgical incision
details (D) belong to medical/surgical scope.
15. Which factors act as significant facilitators for embedding Evidence-Based Practice (EBP)
within a surgical hospital ward? Select all that apply.
A. Access to online health databases and electronic library resources.
B. Ward leadership that supports clinical inquiry and reflective practice.
C. Strict insistence on following historical ward traditions without questioning.
D. Protected time for staff nurses to engage in journal clubs and guidelines review.
E. High patient-to-nurse staffing ratios that minimize shift duration.
F. Availability of clinical nurse specialists to mentor ward staff in research critique.
Answer: A, B, D, F
Rationale: Facilitators of EBP include access to research databases, supportive leadership,
protected time for appraisal, and mentorship by clinical experts (A, B, D, F). Traditionalism (C)
and poor staffing ratios/workload barriers hinder EBP.
16. Which nursing activities demonstrate effective patient advocacy during the perioperative
journey? Select all that apply.
A. Verifying that the surgical consent form was completed voluntarily without coercion.
, B. Halting a procedure during the WHO "Time Out" if a discrepancy in site marking exists.
C. Proceeding with surgery when a patient expresses unaddressed doubts about consent.
D. Ensuring the patient's bodily privacy and dignity are maintained in theatre.
E. Encouraging a patient to voice concerns regarding postoperative pain management.
Answer: A, B, D, E
Rationale: Advocacy involves verifying voluntary consent, stopping procedures for safety
concerns during WHO checks, protecting dignity/privacy, and empowering patient
communication (A, B, D, E). Ignoring patient doubts regarding consent (C) violates patient
advocacy.
Prioritization / Ordered Response (Questions 17–20)
17. Arrange the stages of Patricia Benner's Novice-to-Expert model in correct sequential order
from initial entry into practice to the highest level of mastery.
A. Novice
B. Proficient
C. Competent
D. Advanced Beginner
E. Expert
Answer: A, D, C, B, E
Rationale: Benner's model follows five progressive stages: Novice (A), Advanced Beginner (D),
Competent (C), Proficient (B), and Expert (E).
18. A surgical nurse receives a patient returning to the surgical ward from the Post-Anesthesia
Care Unit (PACU) following major bowel resection. Place the nurse's assessment priorities in
correct sequential order according to clinical urgency.
A. Assess airway patency, respiratory rate, and oxygen saturation.
B. Check blood pressure, heart rate, peripheral perfusion, and cardiac rhythm.
C. Evaluate pain score, level of sedation, and comfort measures.
D. Inspect the surgical abdominal dressing and wound drain outputs.
