Surgical Nursing
Making Connections to Practice
3rd Edition
• Author(s)Janice Hoffman; Nancy
Sullivan
• Print ISBN: 9781719647366
TEST BANK
,1) MCQ
1. Question Number and Type
Question 1 – MCQ
2. Clinical Scenario
A new graduate nurse is caring for a postoperative patient who
says, “I feel dizzy when I sit up.” The patient’s blood pressure is
92/56 mm Hg, heart rate is 118/min, and the dressing has
moderate bloody drainage.
3. Question Stem
Which action should the nurse take first?
4. Answer Options
A. Document the findings and reassess in 30 minutes
B. Assist the patient back to bed and notify the provider
C. Encourage the patient to drink more fluids
D. Apply a new dressing to the incision
5. Correct Answer
B. Assist the patient back to bed and notify the provider
6. Detailed Rationale
The patient shows possible hypovolemia or postoperative
bleeding with orthostatic symptoms, tachycardia, hypotension,
and bleeding at the incision. The first priority is patient safety
and stabilization. Assisting the patient to bed reduces fall risk,
,and notifying the provider supports rapid evaluation and
treatment. This reflects clinical judgment by recognizing
deterioration and taking immediate action.
7. Incorrect Option Analysis
• A. Document the findings and reassess in 30 minutes
o Why incorrect: Delays response to potential shock or
hemorrhage.
o Common misconception: Assuming dizziness is
routine after surgery.
o Safety risk: Fall, worsening hypotension, delayed
treatment of bleeding.
• C. Encourage the patient to drink more fluids
o Why incorrect: Oral fluids do not address possible
active bleeding or unstable vitals.
o Common misconception: Treating low blood pressure
with simple hydration alone.
o Safety risk: Missed hemorrhage, aspiration if the
patient is unstable.
• D. Apply a new dressing to the incision
o Why incorrect: The problem is not just dressing
appearance; the patient may be bleeding internally or
externally.
, o Common misconception: Focusing on the wound
rather than systemic signs.
o Safety risk: Delay in recognizing shock.
8. Nursing Process Linkage
Assessment
9. Clinical Judgment Competencies (NCJMM)
Recognize Cues, Analyze Cues, Take Action
10. Difficulty Level
Moderate
11. Bloom's Cognitive Level
Apply
12. NCLEX Client Needs Category
Physiological Adaptation
13. Key Learning Objective
Identify early signs of postoperative deterioration and prioritize
immediate nursing action.
2) MCQ
1. Question Number and Type
Question 2 – MCQ
2. Clinical Scenario