TEST BANK FOR BRUNNER &
SUDDARTH’S TEXTBOOK OF
MEDICAL-SURGICAL NURSING,
15TH EDITION
COMPREHENSIVE ADULT HEALTH NURSING EXAM RESOURCE
Updated for the 2026/2027 Clinical Practice Guidelines
Prepared By: Clinical Education Task Force Target Audience: Advanced Nursing Students &
Licensure Candidates Curriculum Alignment: Hinkle & Cheever, 15th Edition Clinical
Updates:
● GOLD 2025 Report (COPD)
● 2025 ACC/AHA Heart Failure Guidelines
● 2025 Surviving Sepsis Campaign Updates
● 2025 Diabetes Standards of Care
● Advanced Neurocritical Care Protocols
Introduction: The Evolution of High-Acuity
Nursing Assessment
This comprehensive examination resource is meticulously designed to mirror the rigor and
depth of Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, while
integrating the forward-looking clinical standards projected for the 2026/2027 practice
environment. The medical-surgical landscape is undergoing a paradigm shift, moving from
reactive symptom management to proactive, guideline-directed therapy (GDMT) and precision
medicine.
The following 55 questions utilize a high-fidelity case study format. They require the examinee
to synthesize pathophysiology, pharmacology, and procedural knowledge. A distinctive feature
of this resource is the inclusion of "Next-Generation" clinical reasoning rationales. These
rationales do not merely identify the correct answer; they deconstruct the clinical logic, citing
specific 2025/2026 guideline updates—such as the simultaneous initiation of quadruple therapy
in heart failure or the ABE assessment tool for COPD—that render older practices obsolete.
This ensures that the learner is prepared not just for licensure, but for the complex realities of
modern adult health nursing.
UNIT 1: Principles of Nursing Practice &
Perioperative Concepts
Questions 1–5: Ethics, Genetics, and Perioperative Safety
Question 1: Ethical Decision Making in Genomic Medicine Scenario: A 45-year-old client
,with a strong family history of early-onset breast and ovarian cancer undergoes genetic testing.
The results reveal a BRCA1 mutation. The client confides in the nurse, "I haven't told my sisters
yet because I don't want to worry them, and I forbid you to share this." One sister is currently a
patient in the same clinic for fertility treatments. Utilizing the principles of bioethics and current
privacy regulations (HIPAA), which nursing action is the absolute priority?
A. Breach confidentiality to warn the sister immediately, citing the "Duty to Warn" principle
regarding preventable harm. B. Respect the client’s autonomy and confidentiality, but initiate an
intensive education plan regarding the implications of the mutation for family members,
encouraging self-disclosure. C. Contact the facility's ethics committee to obtain permission to
disclose the result to the sister’s fertility specialist anonymously. D. Document the refusal and
take no further action, as genetic information is protected under GINA (Genetic Information
Nondiscrimination Act) and strictly personal.
● Correct Answer: B. Respect the client’s autonomy and confidentiality, but initiate an
intensive education plan regarding the implications of the mutation for family members,
encouraging self-disclosure.
● Detailed Clinical Rationale: The intersection of genetics and privacy is complex. While
the "Duty to Warn" (Tarasoff) typically applies to immediate threats of physical violence, its
application in genetics is controversial and generally not supported as a mandate to
breach confidentiality in standard practice. The core nursing responsibility is to uphold
confidentiality (non-maleficence/fidelity) while promoting beneficence through patient
education. The nurse must extensively counsel the patient on the importance of "cascade
screening"—the process of identifying relatives at risk—so the patient can make an
informed choice to share. This respects the patient's autonomy while actively working
toward the family's health safety. Breaching confidentiality without a court order or
immediate threat of violence violates HIPAA and professional standards.
● Analysis of Incorrect Options:
○ Option A: The "Duty to Warn" has high legal thresholds (imminent, specific threat).
Genetic risk, while serious, is usually not considered "imminent" enough to legally
justify breaching HIPAA in most jurisdictions without patient consent.
○ Option C: Bypassing the patient to speak to another provider without consent is a
privacy violation.
○ Option D: Passive documentation is insufficient. The nurse has an ethical obligation
to educate and advocate for familial notification, even if they cannot force it.
Question 2: Preoperative Assessment and Medication Safety Scenario: A 72-year-old client
is scheduled for a total knee arthroplasty under general anesthesia. The client has a history of
atrial fibrillation, type 2 diabetes, and hypertension. During the medication reconciliation, the
nurse notes the client took their usual morning dose of Apixaban (Eliquis) and Metformin. What
is the nurse's priority action?
A. Document the intake and proceed to the operating room, as these medications are safe. B.
Notify the anesthesiologist and surgeon immediately, anticipating a cancellation or delay of the
surgery. C. Administer Vitamin K immediately to reverse the anticoagulant effect of Apixaban. D.
Insert a nasogastric tube to suction the medications from the stomach.
● Correct Answer: B. Notify the anesthesiologist and surgeon immediately, anticipating a
cancellation or delay of the surgery.
● Detailed Clinical Rationale: Apixaban is a Direct Oral Anticoagulant (DOAC). Regional
anesthesia (spinal/epidural), often used for knee replacements, and the surgery itself
carry a high risk of bleeding. Guidelines typically require holding Apixaban for 24–48
hours (depending on renal function and bleeding risk) prior to surgery to minimize the risk
, of neuraxial hematoma and surgical hemorrhage. Taking it the morning of surgery is a
critical safety event. Metformin also carries a risk of lactic acidosis if renal function
declines intraoperatively (e.g., hypotension, contrast use). Immediate notification is
required because the surgery likely needs to be postponed until coagulation status is
safe.
● Analysis of Incorrect Options:
○ Option A: Proceeding places the patient at extreme risk for uncontrollable bleeding
or spinal hematoma (paralysis risk).
○ Option C: Vitamin K reverses Warfarin, not DOACs like Apixaban. The reversal
agent for Apixaban is Andexanet alfa, but it is used for life-threatening bleeding, not
routinely for pre-op errors unless emergency surgery is mandated.
○ Option D: NG tube insertion is invasive, uncomfortable, and unlikely to retrieve the
dissolved medication effectively if any time has passed; it also increases bleeding
risk during insertion.
Question 3: Intraoperative Malignant Hyperthermia Crisis Scenario: During the
maintenance phase of anesthesia using Sevoflurane and Succinylcholine, the anesthesiologist
notes a sudden rise in End-Tidal CO2 (ETCO2) from 35 mmHg to 65 mmHg, despite increased
ventilation. The patient’s heart rate rises to 140 bpm, and the jaw muscle is rigid. According to
2024/2025 MHAUS guidelines, what is the perioperative nurse's priority intervention after the
volatile agent is stopped?
A. Administer 100% oxygen and prepare to administer Dantrolene Sodium. B. Apply a cooling
blanket and administer IV Acetaminophen. C. Administer IV Lidocaine to treat the tachycardia.
D. Draw a stat arterial blood gas to confirm metabolic alkalosis.
● Correct Answer: A. Administer 100% oxygen and prepare to administer Dantrolene
Sodium.
● Detailed Clinical Rationale: The scenario describes a classic presentation of Malignant
Hyperthermia (MH): hypercarbia (early sign), tachycardia, and muscle rigidity (masseter
spasm). The immediate treatment sequence is: 1) Stop the triggering agent
(Sevoflurane/Succinylcholine); 2) Hyperventilate with 100% Oxygen (to flush the gas and
manage CO2); 3) Administer Dantrolene Sodium (the only specific antidote). Dantrolene
blocks calcium release from the sarcoplasmic reticulum, halting the hypermetabolic
process. The 2025 guidelines emphasize the rapid reconstitution and administration of
Dantrolene (or the newer Ryanodex formulation) as the single most critical factor in
survival.
● Analysis of Incorrect Options:
○ Option B: Cooling is necessary but secondary to stopping the metabolic engine
(calcium release). Acetaminophen is ineffective for hypermetabolic fever.
○ Option C: Treating the tachycardia with antiarrhythmics without treating the cause
(MH) is futile and delays life-saving therapy.
○ Option D: While an ABG is useful, it would show acidosis, not alkalosis. Diagnostic
tests should never delay the administration of Dantrolene when clinical signs are
evident.
Question 4: Postoperative Dehiscence and Evisceration Scenario: A client is 5 days
postoperative following an open abdominal exploration for a perforated bowel. The client coughs
vigorously and reports a "popping" sensation. The nurse observes a loop of bowel protruding
through the incision. Which action should the nurse take first?
A. Attempt to gently push the bowel back into the abdominal cavity using sterile gloves. B.
Cover the protruding bowel with sterile, saline-soaked gauze and notify the surgeon. C. Apply
SUDDARTH’S TEXTBOOK OF
MEDICAL-SURGICAL NURSING,
15TH EDITION
COMPREHENSIVE ADULT HEALTH NURSING EXAM RESOURCE
Updated for the 2026/2027 Clinical Practice Guidelines
Prepared By: Clinical Education Task Force Target Audience: Advanced Nursing Students &
Licensure Candidates Curriculum Alignment: Hinkle & Cheever, 15th Edition Clinical
Updates:
● GOLD 2025 Report (COPD)
● 2025 ACC/AHA Heart Failure Guidelines
● 2025 Surviving Sepsis Campaign Updates
● 2025 Diabetes Standards of Care
● Advanced Neurocritical Care Protocols
Introduction: The Evolution of High-Acuity
Nursing Assessment
This comprehensive examination resource is meticulously designed to mirror the rigor and
depth of Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, while
integrating the forward-looking clinical standards projected for the 2026/2027 practice
environment. The medical-surgical landscape is undergoing a paradigm shift, moving from
reactive symptom management to proactive, guideline-directed therapy (GDMT) and precision
medicine.
The following 55 questions utilize a high-fidelity case study format. They require the examinee
to synthesize pathophysiology, pharmacology, and procedural knowledge. A distinctive feature
of this resource is the inclusion of "Next-Generation" clinical reasoning rationales. These
rationales do not merely identify the correct answer; they deconstruct the clinical logic, citing
specific 2025/2026 guideline updates—such as the simultaneous initiation of quadruple therapy
in heart failure or the ABE assessment tool for COPD—that render older practices obsolete.
This ensures that the learner is prepared not just for licensure, but for the complex realities of
modern adult health nursing.
UNIT 1: Principles of Nursing Practice &
Perioperative Concepts
Questions 1–5: Ethics, Genetics, and Perioperative Safety
Question 1: Ethical Decision Making in Genomic Medicine Scenario: A 45-year-old client
,with a strong family history of early-onset breast and ovarian cancer undergoes genetic testing.
The results reveal a BRCA1 mutation. The client confides in the nurse, "I haven't told my sisters
yet because I don't want to worry them, and I forbid you to share this." One sister is currently a
patient in the same clinic for fertility treatments. Utilizing the principles of bioethics and current
privacy regulations (HIPAA), which nursing action is the absolute priority?
A. Breach confidentiality to warn the sister immediately, citing the "Duty to Warn" principle
regarding preventable harm. B. Respect the client’s autonomy and confidentiality, but initiate an
intensive education plan regarding the implications of the mutation for family members,
encouraging self-disclosure. C. Contact the facility's ethics committee to obtain permission to
disclose the result to the sister’s fertility specialist anonymously. D. Document the refusal and
take no further action, as genetic information is protected under GINA (Genetic Information
Nondiscrimination Act) and strictly personal.
● Correct Answer: B. Respect the client’s autonomy and confidentiality, but initiate an
intensive education plan regarding the implications of the mutation for family members,
encouraging self-disclosure.
● Detailed Clinical Rationale: The intersection of genetics and privacy is complex. While
the "Duty to Warn" (Tarasoff) typically applies to immediate threats of physical violence, its
application in genetics is controversial and generally not supported as a mandate to
breach confidentiality in standard practice. The core nursing responsibility is to uphold
confidentiality (non-maleficence/fidelity) while promoting beneficence through patient
education. The nurse must extensively counsel the patient on the importance of "cascade
screening"—the process of identifying relatives at risk—so the patient can make an
informed choice to share. This respects the patient's autonomy while actively working
toward the family's health safety. Breaching confidentiality without a court order or
immediate threat of violence violates HIPAA and professional standards.
● Analysis of Incorrect Options:
○ Option A: The "Duty to Warn" has high legal thresholds (imminent, specific threat).
Genetic risk, while serious, is usually not considered "imminent" enough to legally
justify breaching HIPAA in most jurisdictions without patient consent.
○ Option C: Bypassing the patient to speak to another provider without consent is a
privacy violation.
○ Option D: Passive documentation is insufficient. The nurse has an ethical obligation
to educate and advocate for familial notification, even if they cannot force it.
Question 2: Preoperative Assessment and Medication Safety Scenario: A 72-year-old client
is scheduled for a total knee arthroplasty under general anesthesia. The client has a history of
atrial fibrillation, type 2 diabetes, and hypertension. During the medication reconciliation, the
nurse notes the client took their usual morning dose of Apixaban (Eliquis) and Metformin. What
is the nurse's priority action?
A. Document the intake and proceed to the operating room, as these medications are safe. B.
Notify the anesthesiologist and surgeon immediately, anticipating a cancellation or delay of the
surgery. C. Administer Vitamin K immediately to reverse the anticoagulant effect of Apixaban. D.
Insert a nasogastric tube to suction the medications from the stomach.
● Correct Answer: B. Notify the anesthesiologist and surgeon immediately, anticipating a
cancellation or delay of the surgery.
● Detailed Clinical Rationale: Apixaban is a Direct Oral Anticoagulant (DOAC). Regional
anesthesia (spinal/epidural), often used for knee replacements, and the surgery itself
carry a high risk of bleeding. Guidelines typically require holding Apixaban for 24–48
hours (depending on renal function and bleeding risk) prior to surgery to minimize the risk
, of neuraxial hematoma and surgical hemorrhage. Taking it the morning of surgery is a
critical safety event. Metformin also carries a risk of lactic acidosis if renal function
declines intraoperatively (e.g., hypotension, contrast use). Immediate notification is
required because the surgery likely needs to be postponed until coagulation status is
safe.
● Analysis of Incorrect Options:
○ Option A: Proceeding places the patient at extreme risk for uncontrollable bleeding
or spinal hematoma (paralysis risk).
○ Option C: Vitamin K reverses Warfarin, not DOACs like Apixaban. The reversal
agent for Apixaban is Andexanet alfa, but it is used for life-threatening bleeding, not
routinely for pre-op errors unless emergency surgery is mandated.
○ Option D: NG tube insertion is invasive, uncomfortable, and unlikely to retrieve the
dissolved medication effectively if any time has passed; it also increases bleeding
risk during insertion.
Question 3: Intraoperative Malignant Hyperthermia Crisis Scenario: During the
maintenance phase of anesthesia using Sevoflurane and Succinylcholine, the anesthesiologist
notes a sudden rise in End-Tidal CO2 (ETCO2) from 35 mmHg to 65 mmHg, despite increased
ventilation. The patient’s heart rate rises to 140 bpm, and the jaw muscle is rigid. According to
2024/2025 MHAUS guidelines, what is the perioperative nurse's priority intervention after the
volatile agent is stopped?
A. Administer 100% oxygen and prepare to administer Dantrolene Sodium. B. Apply a cooling
blanket and administer IV Acetaminophen. C. Administer IV Lidocaine to treat the tachycardia.
D. Draw a stat arterial blood gas to confirm metabolic alkalosis.
● Correct Answer: A. Administer 100% oxygen and prepare to administer Dantrolene
Sodium.
● Detailed Clinical Rationale: The scenario describes a classic presentation of Malignant
Hyperthermia (MH): hypercarbia (early sign), tachycardia, and muscle rigidity (masseter
spasm). The immediate treatment sequence is: 1) Stop the triggering agent
(Sevoflurane/Succinylcholine); 2) Hyperventilate with 100% Oxygen (to flush the gas and
manage CO2); 3) Administer Dantrolene Sodium (the only specific antidote). Dantrolene
blocks calcium release from the sarcoplasmic reticulum, halting the hypermetabolic
process. The 2025 guidelines emphasize the rapid reconstitution and administration of
Dantrolene (or the newer Ryanodex formulation) as the single most critical factor in
survival.
● Analysis of Incorrect Options:
○ Option B: Cooling is necessary but secondary to stopping the metabolic engine
(calcium release). Acetaminophen is ineffective for hypermetabolic fever.
○ Option C: Treating the tachycardia with antiarrhythmics without treating the cause
(MH) is futile and delays life-saving therapy.
○ Option D: While an ABG is useful, it would show acidosis, not alkalosis. Diagnostic
tests should never delay the administration of Dantrolene when clinical signs are
evident.
Question 4: Postoperative Dehiscence and Evisceration Scenario: A client is 5 days
postoperative following an open abdominal exploration for a perforated bowel. The client coughs
vigorously and reports a "popping" sensation. The nurse observes a loop of bowel protruding
through the incision. Which action should the nurse take first?
A. Attempt to gently push the bowel back into the abdominal cavity using sterile gloves. B.
Cover the protruding bowel with sterile, saline-soaked gauze and notify the surgeon. C. Apply
