2023,202420252026 VATI MEDICAL
SURGICAL FINAL ASSESSMENT
_GUARANTEED PASS A
1. A client is admitted with acute abdominal pain, rigid guarding,
and hypotension. Which action should the nurse take first?
• A) Insert a nasogastric tube
• B) Administer IV morphine
• C) Obtain a complete blood count and type & crossmatch
• D) Prepare for an abdominal CT scan
Rationale: Rigid guarding with hypotension suggests possible
intra-abdominal bleeding (e.g., ruptured ectopic, bleeding ulcer). The
priority is to assess for blood loss (CBC, hemoglobin) and prepare for
possible transfusion (type & crossmatch). Pain medication and NG tube
come after initial stabilization and diagnosis.
2. A patient with type 1 diabetes is planning an east-west flight
crossing 3 time zones. Which instruction is most important?
• A) Take the usual insulin dose regardless of time change
• B) Delay all insulin until after arrival
• C) Adjust insulin based on blood glucose monitoring and the
new meal times
• D) Reduce the long-acting insulin by half the day before travel
,Rationale: Time zone changes require frequent glucose checks and dose
adjustments according to the new schedule. Insulin should never be
withheld entirely, and routine doses may need modification to prevent
hypo- or hyperglycemia.
3. A client returns from a bronchoscopy. Which assessment finding
requires immediate action?
• A) Complaints of a sore throat
• B) Small amount of blood-tinged sputum
• C) Stridor and use of accessory muscles
• D) Hoarse voice
Rationale: Stridor and accessory muscle use indicate upper airway
obstruction (e.g., laryngospasm, edema), a life-threatening complication
after bronchoscopy. Sore throat, mild hemoptysis, and hoarseness are
expected.
4. A patient with a new arteriovenous (AV) fistula for hemodialysis
asks how to check it at home. Which instruction is correct?
• A) “Listen for a bruit with the bell of the stethoscope once a
week.”
• B) “Palpate for a pulse; if absent, call the doctor immediately.”
• C) “Feel for a thrill and listen for a bruit every 4 hours; notify
if either disappears.”
• D) “Apply gentle pressure over the fistula to assess for refill.”
,Rationale: A patent AV fistula has a palpable thrill (vibration) and an
audible bruit (whoosh). These should be checked frequently (e.g., every
4 hours post-op, then daily at home). Loss indicates thrombosis.
5. A nurse receives handoff of four patients. Which one should be
seen first?
• A) Post-appendectomy with pain 6/10
• B) Chest tube to water seal with O₂ saturation 90%
• C) Diabetic with blood glucose 180 mg/dL
• D) Hip arthroplasty patient requesting a bedpan
Rationale: SpO₂ of 90% is below normal (95-100%) and may indicate
pneumothorax, mucus plug, or other respiratory complication. Pain and
blood glucose 180 are not immediate threats; bedpan can wait.
6. A client is started on IV vancomycin. The nurse notes erythema
and pruritus on the face and upper body 10 minutes into the
infusion. What is the priority action?
• A) Stop the infusion and administer diphenhydramine
• B) Slow the infusion rate and notify the provider
• C) Continue at current rate and apply cool compresses
• D) Flush the line with normal saline
Rationale: Red man syndrome (histamine release) occurs when
vancomycin is infused too rapidly. Mild to moderate symptoms are
, managed by slowing the rate; severe cases require stopping. The first
step is to slow or pause, then treat symptomatically.
7. A patient with a traumatic femur fracture develops pain out of
proportion to the injury, paresthesia, and a tense, firm calf. The
nurse suspects:
• A) Fat embolism syndrome
• B) Deep vein thrombosis
• C) Compartment syndrome
• D) Osteomyelitis
Rationale: The classic signs of compartment syndrome are pain with
passive stretch, paresthesia, pallor, paralysis (late), and a tense
compartment. This is an orthopedic emergency requiring fasciotomy.
8. A client has a platelet count of 20,000/mm³. Which precaution is
most important?
• A) Neutropenic precautions
• B) Contact precautions
• C) Bleeding precautions (soft toothbrush, no IM injections)
• D) Airborne precautions
Rationale: Severe thrombocytopenia (<50,000) increases bleeding risk.
Bleeding precautions include avoiding IM injections, using electric
razors, applying pressure after venipuncture, and avoiding rectal temps.
SURGICAL FINAL ASSESSMENT
_GUARANTEED PASS A
1. A client is admitted with acute abdominal pain, rigid guarding,
and hypotension. Which action should the nurse take first?
• A) Insert a nasogastric tube
• B) Administer IV morphine
• C) Obtain a complete blood count and type & crossmatch
• D) Prepare for an abdominal CT scan
Rationale: Rigid guarding with hypotension suggests possible
intra-abdominal bleeding (e.g., ruptured ectopic, bleeding ulcer). The
priority is to assess for blood loss (CBC, hemoglobin) and prepare for
possible transfusion (type & crossmatch). Pain medication and NG tube
come after initial stabilization and diagnosis.
2. A patient with type 1 diabetes is planning an east-west flight
crossing 3 time zones. Which instruction is most important?
• A) Take the usual insulin dose regardless of time change
• B) Delay all insulin until after arrival
• C) Adjust insulin based on blood glucose monitoring and the
new meal times
• D) Reduce the long-acting insulin by half the day before travel
,Rationale: Time zone changes require frequent glucose checks and dose
adjustments according to the new schedule. Insulin should never be
withheld entirely, and routine doses may need modification to prevent
hypo- or hyperglycemia.
3. A client returns from a bronchoscopy. Which assessment finding
requires immediate action?
• A) Complaints of a sore throat
• B) Small amount of blood-tinged sputum
• C) Stridor and use of accessory muscles
• D) Hoarse voice
Rationale: Stridor and accessory muscle use indicate upper airway
obstruction (e.g., laryngospasm, edema), a life-threatening complication
after bronchoscopy. Sore throat, mild hemoptysis, and hoarseness are
expected.
4. A patient with a new arteriovenous (AV) fistula for hemodialysis
asks how to check it at home. Which instruction is correct?
• A) “Listen for a bruit with the bell of the stethoscope once a
week.”
• B) “Palpate for a pulse; if absent, call the doctor immediately.”
• C) “Feel for a thrill and listen for a bruit every 4 hours; notify
if either disappears.”
• D) “Apply gentle pressure over the fistula to assess for refill.”
,Rationale: A patent AV fistula has a palpable thrill (vibration) and an
audible bruit (whoosh). These should be checked frequently (e.g., every
4 hours post-op, then daily at home). Loss indicates thrombosis.
5. A nurse receives handoff of four patients. Which one should be
seen first?
• A) Post-appendectomy with pain 6/10
• B) Chest tube to water seal with O₂ saturation 90%
• C) Diabetic with blood glucose 180 mg/dL
• D) Hip arthroplasty patient requesting a bedpan
Rationale: SpO₂ of 90% is below normal (95-100%) and may indicate
pneumothorax, mucus plug, or other respiratory complication. Pain and
blood glucose 180 are not immediate threats; bedpan can wait.
6. A client is started on IV vancomycin. The nurse notes erythema
and pruritus on the face and upper body 10 minutes into the
infusion. What is the priority action?
• A) Stop the infusion and administer diphenhydramine
• B) Slow the infusion rate and notify the provider
• C) Continue at current rate and apply cool compresses
• D) Flush the line with normal saline
Rationale: Red man syndrome (histamine release) occurs when
vancomycin is infused too rapidly. Mild to moderate symptoms are
, managed by slowing the rate; severe cases require stopping. The first
step is to slow or pause, then treat symptomatically.
7. A patient with a traumatic femur fracture develops pain out of
proportion to the injury, paresthesia, and a tense, firm calf. The
nurse suspects:
• A) Fat embolism syndrome
• B) Deep vein thrombosis
• C) Compartment syndrome
• D) Osteomyelitis
Rationale: The classic signs of compartment syndrome are pain with
passive stretch, paresthesia, pallor, paralysis (late), and a tense
compartment. This is an orthopedic emergency requiring fasciotomy.
8. A client has a platelet count of 20,000/mm³. Which precaution is
most important?
• A) Neutropenic precautions
• B) Contact precautions
• C) Bleeding precautions (soft toothbrush, no IM injections)
• D) Airborne precautions
Rationale: Severe thrombocytopenia (<50,000) increases bleeding risk.
Bleeding precautions include avoiding IM injections, using electric
razors, applying pressure after venipuncture, and avoiding rectal temps.
