Test Bank for Alexander’s Care of the Patient in Surgery 17th Edition by Rothrock

Perioperative nursing is one of the most technically demanding and clinically precise specialties in nursing practice. Before the patient is anesthetized, during the surgical procedure itself, and through the immediate recovery period — the perioperative nurse is responsible for an environment where the margin for error is essentially zero. Sterile fields cannot be compromised. Counts cannot be wrong. Patient identification cannot fail. Positioning errors can cause lasting nerve damage. Instrument malfunctions can turn a routine case into an emergency.

And yet perioperative nursing is also deeply patient-centered. Behind every surgical drape is a person who is frightened, vulnerable, and trusting the team in that room with their life. The perioperative nurse holds both responsibilities simultaneously — technical precision and human compassion — in an environment that moves fast and forgives almost nothing.

Alexander’s Care of the Patient in Surgery has been the definitive perioperative nursing reference for decades. The 17th edition, under Jane Rothrock’s continued editorial leadership, is the most comprehensive and clinically current version yet — covering the full scope of perioperative nursing practice from foundational principles through every major surgical specialty. It reflects updated evidence-based practice guidelines, revised safety protocols, current technological advances in surgical technique, and the expanded nursing role in today’s complex surgical environment.

This test bank was built to match it. Every question is grounded in the clinical standards, safety frameworks, and specialty-specific nursing content of the 17th edition. You do not just study perioperative nursing. You practice thinking through the precise, high-stakes decisions that perioperative nurses make every time the OR doors open.

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What Is Inside

You get over a thousand practice questions covering every major perioperative nursing topic across all surgical specialties in Rothrock’s 17th edition. Questions are written in multiple-choice, select-all-that-apply, and ordered response formats — consistent with what you will encounter on perioperative nursing course exams and the CNOR certification examination.

Every question has a clearly marked correct answer. Every answer includes a full written rationale. The rationale explains the clinical reasoning, safety standard, or evidence-based practice guideline behind the correct choice and addresses specifically why each wrong option reflects an error in technique, a violation of safety protocol, or a departure from evidence-based perioperative nursing practice. In perioperative nursing, where the consequences of error can be immediate and catastrophic, that depth of explanation is not supplementary — it is essential.

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Topics Covered

The test bank follows the complete structure of Rothrock’s 17th edition across every major perioperative nursing content area, including:

Foundations of Perioperative Nursing — the perioperative nursing role and scope of practice, the perioperative nursing data set and nursing process in surgical settings, patient-centered care in the perioperative environment, evidence-based perioperative nursing practice, legal and ethical considerations in surgical nursing, professional accountability and perioperative nursing standards, and the history and evolution of perioperative nursing as a specialty

Patient Safety in the Surgical Environment — The Joint Commission National Patient Safety Goals in surgical settings, the Universal Protocol including pre-procedure verification, site marking, and time-out procedures, wrong-site surgery prevention, retained surgical item prevention and surgical counting procedures, surgical fire prevention and management, safe patient handling and positioning in the OR, and medication safety in the perioperative setting

Infection Prevention and Aseptic Technique — principles of surgical asepsis and sterile technique, the surgical conscience, sterilization methods including steam, ethylene oxide, hydrogen peroxide plasma, and other technologies, high-level disinfection, perioperative hand hygiene including surgical hand scrub and alcohol-based handrub technique, gowning and gloving procedures, establishment and maintenance of the sterile field, surgical site infection prevention bundles, traffic patterns in the OR, and OSHA standards in the surgical environment

The Surgical Environment and Equipment — operating room design and layout, environmental controls including temperature, humidity, and air exchange requirements, electrosurgical unit principles and safety, ultrasonic energy devices, laser safety in the OR, endoscopic equipment and robotic surgical system setup and safety, surgical lighting, and equipment inspection and maintenance responsibilities

Preoperative Nursing Care — preoperative patient assessment, identification of surgical risk factors, preoperative diagnostic screening, NPO guidelines and preoperative preparation, informed consent and the nurse’s role, preoperative patient and family education, skin preparation and antimicrobial prophylaxis, venous thromboembolism prophylaxis in surgical patients, and preoperative checklist completion and handoff communication

Intraoperative Nursing Care — circulating nurse responsibilities, scrub role responsibilities, intraoperative patient positioning including supine, Trendelenburg, lithotomy, lateral, prone, and sitting positions with associated nerve injury risks, surgical counts including soft goods, sharps, and instruments, specimen handling and chain of custody, medication management on the sterile field, blood and blood product management intraoperatively, intraoperative documentation, and handoff communication at shift change during prolonged procedures

Anesthesia and the Perioperative Nurse — types of anesthesia including general, regional, monitored anesthesia care, and local anesthesia, the anesthesia care team and nursing collaboration, malignant hyperthermia recognition and emergency management, anesthesia-related nursing responsibilities, emergence from anesthesia and extubation, and management of anesthesia-related complications

Wound Management — wound classification by contamination level, wound closure methods including primary, secondary, and delayed primary closure, suture materials and selection principles, surgical drains and drainage systems, wound dressing selection, and surgical wound healing and complications

Postoperative Nursing Care and PACU — post-anesthesia care unit nursing assessment and monitoring, the Aldrete scoring system and discharge criteria, management of common postoperative complications including airway obstruction, nausea and vomiting, pain, hypothermia, hypotension, and bleeding, hand-off communication from OR to PACU, and phase 1 and phase 2 recovery nursing care

Surgical Pharmacology — anesthetic agents and their perioperative nursing implications, neuromuscular blocking agents, reversal agents, hemostatic agents, anticoagulant management in the perioperative period, topical medications used in surgery, and contrast media and associated nursing responsibilities

Specialty Surgical Nursing — General Surgery — laparoscopic and open abdominal procedures, gastrointestinal surgery including bowel resection and ostomy creation, hernia repair, appendectomy, cholecystectomy, splenectomy, hepatic and pancreatic surgery, and bariatric surgery nursing

Specialty Surgical Nursing — Cardiovascular and Thoracic Surgery — open heart surgery and cardiopulmonary bypass, coronary artery bypass grafting, valve repair and replacement, aortic aneurysm repair, cardiac rhythm device implantation, thoracic surgery including pneumonectomy and lobectomy, thoracoscopic procedures, and vascular surgery nursing

Specialty Surgical Nursing — Orthopedic Surgery — total joint replacement including hip and knee arthroplasty, fracture repair and fixation, arthroscopic procedures, spine surgery nursing, and amputation surgery

Specialty Surgical Nursing — Neurological Surgery — craniotomy nursing care, spinal cord surgery, neurovascular procedures, and stereotactic and robotic neurosurgical applications

Specialty Surgical Nursing — Genitourinary Surgery — urologic endoscopy, transurethral procedures, nephrectomy, cystectomy, prostatectomy, renal transplantation, and robotic urological procedures

Specialty Surgical Nursing — Obstetric and Gynecologic Surgery — cesarean birth, hysterectomy, laparoscopic gynecologic procedures, pelvic floor repair, and gynecologic oncology surgery

Specialty Surgical Nursing — Ophthalmic Surgery — cataract surgery, glaucoma procedures, retinal surgery, corneal transplantation, and oculoplastic procedures with associated nursing considerations

Specialty Surgical Nursing — Otorhinolaryngologic Surgery — tonsillectomy and adenoidectomy, ear surgery including tympanoplasty and cochlear implant, nasal surgery, laryngoscopy, and head and neck cancer surgery

Specialty Surgical Nursing — Plastic and Reconstructive Surgery — wound and burn reconstruction, flap procedures, cosmetic surgical procedures, breast reconstruction, and hand surgery nursing

Specialty Surgical Nursing — Pediatric Surgery — anatomical and physiological considerations unique to pediatric surgical patients, common pediatric surgical procedures, family-centered care in pediatric perioperative nursing, and temperature regulation in pediatric surgical patients

Specialty Surgical Nursing — Geriatric Surgical Patients — age-related physiological changes affecting surgical risk, delirium prevention in elderly surgical patients, thermoregulation challenges, and modified perioperative nursing approaches for older adults

Transplantation Surgery — organ procurement and preservation, solid organ transplantation including renal, hepatic, cardiac, and pulmonary transplantation, multiorgan procurement nursing, and immunosuppression considerations in the perioperative period

Minimally Invasive and Robotic Surgery — principles of laparoscopic and thoracoscopic surgery, robotic surgical system setup, draping, and troubleshooting, single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and nursing considerations in robotic-assisted procedures

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Who Should Use This

This test bank is the right resource for perioperative nursing students and OR nursing residents whose programs use Rothrock’s 17th edition, registered nurses transitioning into perioperative nursing who want to build comprehensive specialty knowledge before or during OR orientation, nurses preparing for the CNOR certification examination who need a systematic, high-volume question-based review across all major perioperative content areas, scrub technologist students who want to deepen their perioperative knowledge beyond technical skills, nursing faculty teaching perioperative nursing specialty courses who need a rigorous and clinically grounded question pool for building course assessments, and perioperative nursing educators in hospital-based OR training programs who need assessment tools aligned with the current edition of Alexander’s.

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Why the 17th Edition Specifically

Perioperative nursing practice evolves with every advance in surgical technology and every revision of safety standards. The 17th edition of Alexander’s reflects the most current evidence-based perioperative practice — including updated Universal Protocol and surgical safety checklist implementation, current AORN evidence-based practice guidelines, advances in robotic and minimally invasive surgical technology, updated sterilization and high-level disinfection guidance, revised SSI prevention bundles, expanded content on enhanced recovery after surgery protocols, and updated guidance on fire safety, retained surgical items, and wrong-site surgery prevention.

This test bank was written to align with the 17th edition specifically. The safety protocols, clinical standards, sterilization guidelines, and specialty-specific nursing content in the questions reflect what is in this edition. If your training or certification preparation uses the 17th edition, this is the resource that matches it.

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5 Sample Questions

Question 1
A circulating nurse is preparing for a laparoscopic cholecystectomy. Just before incision, the attending surgeon realizes the consent form lists the patient’s name incorrectly and does not specify the operative site. The team is ready to proceed and the surgeon states the error is minor and wants to move forward. Which action by the circulating nurse best reflects perioperative safety standards?

A. Defer to the surgeon’s judgment since the verbal identification is sufficient and the procedure is straightforward
B. Halt the procedure and address the consent documentation error before any incision is made, regardless of the surgeon’s preference
C. Proceed with the case and correct the consent form retroactively after the procedure is complete
D. Ask the scrub technologist to initial the consent form as a witness to verbal confirmation and proceed

Correct Answer: B
The Universal Protocol requires that a valid, complete, and accurate informed consent document be present and verified before any surgical procedure begins. An incorrect patient name and absence of procedure specification on the consent are not minor clerical issues — they are patient safety failures that could mask a wrong-patient or wrong-procedure scenario. The circulating nurse has a professional, legal, and ethical obligation to halt the procedure and ensure the consent error is corrected through the appropriate process before the case continues. The surgeon’s preference to proceed does not override this safety standard. No member of the surgical team has the authority to waive the Universal Protocol requirements, regardless of case complexity or time pressure.

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Question 2
A scrub nurse notices that the soft goods count at the end of a laparotomy is incorrect — one laparotomy sponge is unaccounted for. The surgeon states the wound looks clear and begins to close. Which nursing action is most appropriate?

A. Document the discrepancy and allow closure to proceed since the surgeon has visually inspected the field
B. Immediately inform the surgeon of the count discrepancy, request that the wound be explored before closure, and notify the circulating nurse to initiate the facility’s retained item protocol including intraoperative imaging
C. Recount the sponges a second time and if the count remains incorrect, document the exception and proceed with closure
D. Ask the anesthesia provider to check under the drapes for the missing sponge before escalating the issue

Correct Answer: B
A discrepant surgical count is a patient safety emergency that requires immediate action regardless of the surgeon’s subjective assessment of the wound. The scrub nurse must immediately and clearly communicate the count discrepancy to the surgeon and circulating nurse, halt closure, and initiate the facility’s retained surgical item protocol — which typically includes a thorough wound exploration and intraoperative radiographic imaging before the incision is closed. Visual inspection alone is insufficient to exclude a retained item in the abdominal cavity. A retained surgical sponge can cause abscess formation, bowel perforation, sepsis, and death. The nurse’s obligation to the patient’s safety supersedes deference to the surgeon’s preference to proceed with closure.

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Question 3
A patient in the operating room suddenly develops a temperature of 40.8°C, muscle rigidity, masseter spasm, and cola-colored urine shortly after induction with succinylcholine. The end-tidal CO₂ reading is rapidly rising. Which condition does the perioperative nurse recognize and what is the priority nursing action?

A. Sepsis — obtain blood cultures and notify the surgical team to postpone the case
B. Malignant hyperthermia — activate the MH protocol, call for dantrolene, and prepare to assist with immediate management
C. Neuroleptic malignant syndrome — discontinue the anesthetic and administer a dopamine agonist
D. Thyroid storm — notify the endocrinology team and administer propylthiouracil

Correct Answer: B
The constellation of rapidly rising temperature, muscle rigidity, masseter spasm, cola-colored urine indicating myoglobinuria, and rising end-tidal CO₂ following succinylcholine administration is the hallmark presentation of malignant hyperthermia — a life-threatening pharmacogenetic disorder of skeletal muscle calcium regulation triggered by volatile anesthetic agents and succinylcholine. This is a perioperative emergency with a mortality rate that approaches 70% if untreated. The perioperative nurse must immediately activate the MH protocol, call for dantrolene — the only specific treatment — and assist with discontinuing the triggering agent, hyperventilating with 100% oxygen, active cooling measures, correction of metabolic acidosis, and monitoring for dysrhythmias. Every OR should have dantrolene stocked and staff trained for this emergency, per AORN and MHAUS guidelines.

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Question 4
A perioperative nurse is setting up for a procedure that will use a laser. Which safety measure is the highest priority before the laser is activated?

A. Ensure the laser safety officer is present in the room during the entire procedure
B. Apply wet towels or laser-safe draping around the surgical site, ensure all team members are wearing appropriate optical density eyewear specific to the laser wavelength in use, and confirm that warning signs are posted outside the OR doors
C. Verify that the electrosurgical unit has been turned off since it cannot be used in the same procedure as a laser
D. Confirm the patient has signed a separate laser consent in addition to the surgical consent

Correct Answer: B
Laser safety in the operating room requires a comprehensive set of precautions before activation. The highest priority measures include protecting surrounding tissue with wet materials to prevent fire, ensuring all team members including the patient are wearing the correct optical density eyewear specific to the wavelength of the laser being used — because different lasers require different protective specifications — and posting warning signs outside all OR doors to prevent inadvertent entry without eye protection. Laser and electrosurgical energy can sometimes be used in the same case with appropriate precautions, and while a laser safety officer or designee is responsible for safety oversight, their continuous presence in the room is not always mandated. A separate laser consent may be required by some facilities but is not universally the highest priority safety action.

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Question 5
A patient positioned in the lithotomy position for a prolonged urological procedure complains of severe calf pain and weakness in both legs upon return to the supine position at the end of the case. The legs appear pale and cool. Which complication does the perioperative nurse recognize and what is the priority action?

A. Postoperative neuropathy from regional anesthesia — reassure the patient that sensation will return when the block wears off
B. Compartment syndrome of the lower extremities from prolonged lithotomy positioning — notify the surgeon immediately and prepare for urgent intervention
C. Deep vein thrombosis from venous stasis during the procedure — apply compression stockings and notify the provider
D. Positional hypotension causing peripheral vasoconstriction — lower the head of the bed and administer IV fluids

Correct Answer: B
Prolonged lithotomy positioning — particularly beyond two hours — is a well-documented risk factor for lower extremity compartment syndrome due to sustained elevation of the legs above the level of the heart, which impairs arterial perfusion and venous return. Pain, pallor, weakness, and coolness in both lower extremities following lithotomy position are warning signs of compartment syndrome, which is a surgical emergency. Without prompt diagnosis and fasciotomy to relieve compartmental pressure, ischemia can progress to irreversible nerve and muscle damage and limb loss. The perioperative nurse must recognize this complication, notify the surgeon immediately, and prepare for urgent surgical intervention. Attributing these findings to anesthesia effects or positional hypotension delays potentially limb-saving treatment.

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Frequently Asked Questions

Is this the official Elsevier test bank for Rothrock’s 17th edition?
No. This is an independently developed study resource based on the content of Jane Rothrock’s 17th edition. It is not published or endorsed by Elsevier or the original author. It is a supplementary exam and certification preparation tool for perioperative nursing students, OR nurses, and faculty.

How many questions are in the test bank?
There are over a thousand questions distributed across all major perioperative nursing content areas and surgical specialties in the 17th edition, with strong representation in the highest-yield areas including surgical safety, aseptic technique, intraoperative nursing responsibilities, anesthesia-related nursing care, and specialty surgical nursing.

Can this test bank help me prepare for the CNOR certification examination?
Yes. The content in Rothrock’s 17th edition maps closely to the CNOR examination blueprint developed by the Competency and Credentialing Institute, and the questions in this test bank are written at the application and analysis levels the CNOR demands. It works well as a supplementary resource alongside a dedicated CNOR review program.

I am a new graduate nurse transitioning into the OR. Is this test bank appropriate for me during orientation?
Yes. OR orientation is an intensive and sometimes overwhelming experience. Using this test bank alongside your preceptorship helps solidify the theoretical foundations behind what you are learning in the room — particularly around sterile technique principles, count procedures, safety protocols, and specialty-specific nursing considerations that may not all be immediately visible in any single clinical case.

Does this test bank cover robotic surgery nursing?
Yes. Robotic surgical system setup, draping, troubleshooting, and nursing considerations for robotic-assisted procedures are included in the test bank, reflecting the expanded coverage of minimally invasive and robotic surgery in the 17th edition.

Does every question include a rationale?
Yes, without exception. Every question has a correct answer and a full written rationale that explains the safety standard, evidence-based guideline, or clinical reasoning behind the correct choice and addresses why each wrong option reflects an error in perioperative practice. In an environment where errors can result in immediate patient harm, understanding the reasoning behind every decision is a professional imperative, not just an exam strategy.

Can nursing faculty or OR educators use this to build perioperative course assessments?
Yes. Questions are organized by chapter and content area, making it straightforward to build unit quizzes, competency assessments, or comprehensive examinations across perioperative nursing foundations, intraoperative nursing responsibilities, and specific surgical specialties.

What file format is the test bank delivered in?
It comes as a digital file, typically in Word or PDF format. You can search by surgical specialty, safety topic, or clinical concept, print specific chapters for focused study sessions, and access it across multiple devices. Many perioperative nurses preparing for the CNOR organize their review by content domain — working through all safety-related questions first, then proceeding through each surgical specialty.

Is this test bank specific to the 17th edition only?
Yes. It was written to align with the clinical standards, AORN evidence-based practice guidelines, safety protocols, and surgical specialty content of the 17th edition specifically. Perioperative nursing guidelines — including sterilization standards, SSI prevention bundles, and fire safety protocols — are updated regularly, and earlier editions may not reflect current evidence-based practice. Always confirm your edition before purchasing.