Brunner & Suddarth Medical-Surgical Nursing 16th Edition
Test Bank | Complete Solutions - 249 Questions
This exam assesses advanced knowledge of perioperative nursing, including preoperative assessment,
intraoperative management, and postoperative complications. Questions require synthesis of pathophysiology,
pharmacology, and evidence-based practice. It contains 249 multiple-choice questions, each with four distractors
and a fully worked rationale that explains why the keyed answer is correct. Content is organized into 12 focused
sections: Perioperative Nursing, Fluid, Electrolyte, and Acid-Base Balance, Pain Management, Cardiovascular
System, Respiratory System, Gastrointestinal System, Renal and Urinary System, Endocrine System, Neurologic
System, Musculoskeletal System, Integumentary System, Oncology and Hematology. Targeted learning outcomes
include: Analyze risk factors and implement preventive strategies for perioperative complications.; Interpret
hemodynamic and laboratory data to guide intraoperative and postoperative care.; Evaluate the impact of patient
comorbidities on surgical outcomes and nursing interventions.. Every item has been reviewed for clinical
accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as they work
through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice tool
during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours, with a
passing score of 85%. Aligned with Conforms to AACN and CCNE standards for baccalaureate nursing
education. standards and reflects the question style commonly seen on accredited program examinations. Students
Section 1: Perioperative Nursing (Questions 1-20)
1 A patient with a history of chronic obstructive pulmonary disease (COPD) is
scheduled for elective abdominal surgery. Which preoperative intervention is
most critical to reduce the risk of postoperative pulmonary complications?
A) Administering prophylactic antibiotics 30 minutes before incision
B) Instructing the patient in incentive spirometry and deep breathing
exercises
C) Prescribing a low-sodium diet for 48 hours preoperatively
D) Obtaining a baseline arterial blood gas (ABG) on room air
Answer: B
Rationale: Incentive spirometry and deep breathing exercises are
evidence-based interventions to prevent atelectasis and pneumonia in COPD
patients. Prophylactic antibiotics target infection, not pulmonary function.
Low-sodium diet is irrelevant. Baseline ABG is useful but not a direct
intervention to reduce complications.
2 During the intraoperative phase, a patient under general anesthesia develops
a sudden increase in end-tidal carbon dioxide (ETCO2) and a decrease in
oxygen saturation. Which complication should the nurse suspect first?
A) Malignant hyperthermia
B) Pulmonary embolism
,C) Hypovolemia
D) Awareness under anesthesia
Answer: A
Rationale: Malignant hyperthermia presents with increased ETCO2,
tachycardia, and hyperthermia due to uncontrolled calcium release in muscle
cells. Pulmonary embolism would cause decreased ETCO2. Hypovolemia does
not directly increase ETCO2. Awareness does not affect ETCO2.
3 Which of the following findings in a patient's preoperative assessment would
necessitate postponement of elective surgery?
A) Hemoglobin 11.5 g/dL
B) Serum potassium 3.2 mEq/L
C) White blood cell count 10,500/mm³
D) Prothrombin time 12 seconds
Answer: B
Rationale: Hypokalemia (K+ <3.5 mEq/L) increases risk of cardiac arrhythmias
during surgery and anesthesia. Hemoglobin 11.5 g/dL is acceptable for most
elective surgeries. WBC 10,500 is slightly elevated but not a contraindication.
PT 12 seconds is normal.
4 A patient is receiving moderate sedation for a colonoscopy. Which
assessment finding indicates that the sedation level is too deep?
A) The patient responds to verbal commands with slurred speech
B) The patient has a respiratory rate of 10 breaths per minute and does not
respond to mild stimulation
C) The patient's blood pressure is 10% below baseline
D) The patient's oxygen saturation is 92% on room air
Answer: B
Rationale: Moderate sedation should maintain purposeful response to verbal or
light tactile stimulation. A respiratory rate of 10 with no response indicates
deep sedation, risking airway compromise. Slurred speech is expected. BP drop
of 10% is acceptable. SpO2 92% may be acceptable but is not the primary
indicator of depth.
,5 A patient develops postoperative nausea and vomiting (PONV) after
laparoscopic cholecystectomy. Which intervention is most appropriate
initially?
A) Administer ondansetron 4 mg intravenously
B) Place the patient in a supine position with head elevated
C) Insert a nasogastric tube for decompression
D) Encourage oral intake of clear fluids
Answer: A
Rationale: Ondansetron, a 5-HT3 antagonist, is first-line for PONV. Positioning
supine increases aspiration risk; lateral or semi-Fowler's is safer. NG tube is
invasive and not first-line. Oral intake may worsen nausea.
6 A patient in the post-anesthesia care unit (PACU) has a core temperature of
35.5°C (95.9°F). Which nursing action is most appropriate?
A) Apply forced-air warming device
B) Administer acetaminophen 650 mg rectally
C) Increase IV fluid rate to 200 mL/hour
D) Monitor temperature every 30 minutes without active warming
Answer: A
Rationale: Hypothermia (<36°C) increases risk of cardiac events, coagulopathy,
and infection. Active warming with forced air is standard. Acetaminophen
treats fever, not hypothermia. IV fluids do not warm core. Monitoring alone is
insufficient.
7 A patient with a history of hypertension and diabetes is undergoing a total
hip arthroplasty under spinal anesthesia. Which intraoperative finding
requires immediate intervention?
A) Heart rate 55 beats per minute
B) Blood pressure 85/50 mm Hg
C) Respiratory rate 16 breaths per minute
D) Oxygen saturation 97% on 2 L nasal cannula
Answer: B
Rationale: Spinal anesthesia can cause sympathetic blockade leading to
hypotension. BP 85/50 indicates significant hypotension requiring vasopressors
or fluids. HR 55 may be normal. RR 16 and SpO2 97% are adequate.
, 8 A patient is 24 hours post-operative from a colectomy. The nurse notes that
the patient's urine output has been 20 mL/hour for the past 4 hours. Which
action should the nurse take first?
A) Notify the healthcare provider immediately
B) Increase the IV fluid rate as prescribed
C) Assess the patient's bladder for distention
D) Obtain a serum creatinine level
Answer: C
Rationale: Oliguria (<30 mL/hour) requires assessment of fluid volume status
and bladder distention. A distended bladder may indicate urinary retention, a
common postoperative issue. Notifying the provider is premature without
assessment. Increasing fluids could worsen fluid overload if retention is the
cause. Creatinine is useful but not first step.
9 Which of the following surgical wound classifications is correctly matched
with an example?
A) Clean-contaminated - elective inguinal hernia repair
B) Contaminated - open traumatic fracture repair
C) Dirty - elective cholecystectomy with entry into the biliary tract
D) Clean - appendectomy for perforated appendix
Answer: B
Rationale: Open traumatic fractures are contaminated due to exposure to dirt
and bacteria. Clean-contaminated involves entry into respiratory, alimentary, or
genitourinary tracts without spillage (e.g., cholecystectomy). Clean wounds are
uninfected, non-inflammatory (e.g., hernia repair). Dirty wounds include
perforated viscera (e.g., perforated appendix).
10 A patient receiving intravenous patient-controlled analgesia (PCA) with
morphine after abdominal surgery has a respiratory rate of 8 breaths per
minute. Which action should the nurse take first?
A) Administer naloxone 0.4 mg intravenously
B) Stop the PCA infusion
C) Apply supplemental oxygen at 2 L/min via nasal cannula
D) Arouse the patient and instruct to take deep breaths
Answer: B
Test Bank | Complete Solutions - 249 Questions
This exam assesses advanced knowledge of perioperative nursing, including preoperative assessment,
intraoperative management, and postoperative complications. Questions require synthesis of pathophysiology,
pharmacology, and evidence-based practice. It contains 249 multiple-choice questions, each with four distractors
and a fully worked rationale that explains why the keyed answer is correct. Content is organized into 12 focused
sections: Perioperative Nursing, Fluid, Electrolyte, and Acid-Base Balance, Pain Management, Cardiovascular
System, Respiratory System, Gastrointestinal System, Renal and Urinary System, Endocrine System, Neurologic
System, Musculoskeletal System, Integumentary System, Oncology and Hematology. Targeted learning outcomes
include: Analyze risk factors and implement preventive strategies for perioperative complications.; Interpret
hemodynamic and laboratory data to guide intraoperative and postoperative care.; Evaluate the impact of patient
comorbidities on surgical outcomes and nursing interventions.. Every item has been reviewed for clinical
accuracy, current guidelines, and clarity so that students can study with confidence and self-correct as they work
through the bank. Use it as a high-yield review immediately before the exam, or as a structured practice tool
during the unit - the rationales double as concise teaching notes. The recommended writing time is 3 hours, with a
passing score of 85%. Aligned with Conforms to AACN and CCNE standards for baccalaureate nursing
education. standards and reflects the question style commonly seen on accredited program examinations. Students
Section 1: Perioperative Nursing (Questions 1-20)
1 A patient with a history of chronic obstructive pulmonary disease (COPD) is
scheduled for elective abdominal surgery. Which preoperative intervention is
most critical to reduce the risk of postoperative pulmonary complications?
A) Administering prophylactic antibiotics 30 minutes before incision
B) Instructing the patient in incentive spirometry and deep breathing
exercises
C) Prescribing a low-sodium diet for 48 hours preoperatively
D) Obtaining a baseline arterial blood gas (ABG) on room air
Answer: B
Rationale: Incentive spirometry and deep breathing exercises are
evidence-based interventions to prevent atelectasis and pneumonia in COPD
patients. Prophylactic antibiotics target infection, not pulmonary function.
Low-sodium diet is irrelevant. Baseline ABG is useful but not a direct
intervention to reduce complications.
2 During the intraoperative phase, a patient under general anesthesia develops
a sudden increase in end-tidal carbon dioxide (ETCO2) and a decrease in
oxygen saturation. Which complication should the nurse suspect first?
A) Malignant hyperthermia
B) Pulmonary embolism
,C) Hypovolemia
D) Awareness under anesthesia
Answer: A
Rationale: Malignant hyperthermia presents with increased ETCO2,
tachycardia, and hyperthermia due to uncontrolled calcium release in muscle
cells. Pulmonary embolism would cause decreased ETCO2. Hypovolemia does
not directly increase ETCO2. Awareness does not affect ETCO2.
3 Which of the following findings in a patient's preoperative assessment would
necessitate postponement of elective surgery?
A) Hemoglobin 11.5 g/dL
B) Serum potassium 3.2 mEq/L
C) White blood cell count 10,500/mm³
D) Prothrombin time 12 seconds
Answer: B
Rationale: Hypokalemia (K+ <3.5 mEq/L) increases risk of cardiac arrhythmias
during surgery and anesthesia. Hemoglobin 11.5 g/dL is acceptable for most
elective surgeries. WBC 10,500 is slightly elevated but not a contraindication.
PT 12 seconds is normal.
4 A patient is receiving moderate sedation for a colonoscopy. Which
assessment finding indicates that the sedation level is too deep?
A) The patient responds to verbal commands with slurred speech
B) The patient has a respiratory rate of 10 breaths per minute and does not
respond to mild stimulation
C) The patient's blood pressure is 10% below baseline
D) The patient's oxygen saturation is 92% on room air
Answer: B
Rationale: Moderate sedation should maintain purposeful response to verbal or
light tactile stimulation. A respiratory rate of 10 with no response indicates
deep sedation, risking airway compromise. Slurred speech is expected. BP drop
of 10% is acceptable. SpO2 92% may be acceptable but is not the primary
indicator of depth.
,5 A patient develops postoperative nausea and vomiting (PONV) after
laparoscopic cholecystectomy. Which intervention is most appropriate
initially?
A) Administer ondansetron 4 mg intravenously
B) Place the patient in a supine position with head elevated
C) Insert a nasogastric tube for decompression
D) Encourage oral intake of clear fluids
Answer: A
Rationale: Ondansetron, a 5-HT3 antagonist, is first-line for PONV. Positioning
supine increases aspiration risk; lateral or semi-Fowler's is safer. NG tube is
invasive and not first-line. Oral intake may worsen nausea.
6 A patient in the post-anesthesia care unit (PACU) has a core temperature of
35.5°C (95.9°F). Which nursing action is most appropriate?
A) Apply forced-air warming device
B) Administer acetaminophen 650 mg rectally
C) Increase IV fluid rate to 200 mL/hour
D) Monitor temperature every 30 minutes without active warming
Answer: A
Rationale: Hypothermia (<36°C) increases risk of cardiac events, coagulopathy,
and infection. Active warming with forced air is standard. Acetaminophen
treats fever, not hypothermia. IV fluids do not warm core. Monitoring alone is
insufficient.
7 A patient with a history of hypertension and diabetes is undergoing a total
hip arthroplasty under spinal anesthesia. Which intraoperative finding
requires immediate intervention?
A) Heart rate 55 beats per minute
B) Blood pressure 85/50 mm Hg
C) Respiratory rate 16 breaths per minute
D) Oxygen saturation 97% on 2 L nasal cannula
Answer: B
Rationale: Spinal anesthesia can cause sympathetic blockade leading to
hypotension. BP 85/50 indicates significant hypotension requiring vasopressors
or fluids. HR 55 may be normal. RR 16 and SpO2 97% are adequate.
, 8 A patient is 24 hours post-operative from a colectomy. The nurse notes that
the patient's urine output has been 20 mL/hour for the past 4 hours. Which
action should the nurse take first?
A) Notify the healthcare provider immediately
B) Increase the IV fluid rate as prescribed
C) Assess the patient's bladder for distention
D) Obtain a serum creatinine level
Answer: C
Rationale: Oliguria (<30 mL/hour) requires assessment of fluid volume status
and bladder distention. A distended bladder may indicate urinary retention, a
common postoperative issue. Notifying the provider is premature without
assessment. Increasing fluids could worsen fluid overload if retention is the
cause. Creatinine is useful but not first step.
9 Which of the following surgical wound classifications is correctly matched
with an example?
A) Clean-contaminated - elective inguinal hernia repair
B) Contaminated - open traumatic fracture repair
C) Dirty - elective cholecystectomy with entry into the biliary tract
D) Clean - appendectomy for perforated appendix
Answer: B
Rationale: Open traumatic fractures are contaminated due to exposure to dirt
and bacteria. Clean-contaminated involves entry into respiratory, alimentary, or
genitourinary tracts without spillage (e.g., cholecystectomy). Clean wounds are
uninfected, non-inflammatory (e.g., hernia repair). Dirty wounds include
perforated viscera (e.g., perforated appendix).
10 A patient receiving intravenous patient-controlled analgesia (PCA) with
morphine after abdominal surgery has a respiratory rate of 8 breaths per
minute. Which action should the nurse take first?
A) Administer naloxone 0.4 mg intravenously
B) Stop the PCA infusion
C) Apply supplemental oxygen at 2 L/min via nasal cannula
D) Arouse the patient and instruct to take deep breaths
Answer: B
