Free CPSN Practice Questions

Question 1

Six hours after free-flap breast reconstruction, the skin paddle changes from pink and soft to dusky, swollen, and tense. Capillary refill is now less than 1 second. The arterial Doppler signal remains audible at the marked site, and the patient's blood pressure is unchanged. Which interpretation best reconciles these findings?

Accepted Answer

Venous outflow is impaired despite continued arterial inflow.

Answer

Arterial inflow has stopped because the arterial anastomosis has thrombosed.

Answer

Expected postoperative edema is occurring without impaired flap circulation.

Answer

Systemic hypovolemia is reducing blood flow throughout the flap.

Question 2

During a feeding observation, a 3-week-old infant with an unrepaired cleft palate sucks vigorously on a standard bottle but transfers little milk; feeds routinely last 45 minutes. The infant coordinates swallowing and breathing without coughing or distress, and the feeding team considers oral feeding appropriate. What change most directly addresses the feeding difficulty?

Accepted Answer

Use a cleft-adapted feeder with the infant upright, pacing assisted flow with sucking and breathing.

Answer

Use a vented standard bottle to reduce nipple collapse while preserving the infant's usual sucking technique.

Answer

Use a slower-flow nipple and extend each feeding so that the infant can finish the prescribed volume.

Answer

Replace oral feeds with nasogastric feeds until palate repair can restore effective suction.

Question 3

The medication record for a 68-kg adult undergoing cosmetic scar revision shows that 8 mL of 2% plain lidocaine has already been infiltrated. The surgeon requests another 12 mL of 1% plain lidocaine. No other local anesthetic has been administered. For this conventional, nontumescent infiltration, the procedure's lidocaine ceiling is 4.5 mg/kg, not to exceed 300 mg. How should the nurse assess the requested additional dose?

Accepted Answer

The cumulative dose would be 280 mg, below the applicable 300-mg ceiling.

Answer

The cumulative dose would be 400 mg, above the applicable 300-mg ceiling.

Answer

The cumulative dose would be 200 mg, below the applicable 300-mg ceiling.

Answer

The cumulative dose would be 120 mg, below the applicable 300-mg ceiling.

Question 4

Eight years after mastectomy reconstruction with a textured implant, a patient develops new unilateral breast swelling. There is no fever or erythema. Ultrasound shows a substantial peri-implant fluid collection and an intact implant shell. Which diagnostic plan should the nurse anticipate?

Accepted Answer

Aspiration with fresh fluid sent for cytology and appropriate CD30 and ALK testing.

Answer

An empirical antibiotic course, with fluid sampling only if swelling persists after treatment.

Answer

Implant exchange for presumed silent rupture, with testing limited to the removed implant shell.

Answer

Therapeutic aspiration followed by repeat imaging, reserving laboratory evaluation for a recurrent collection.

Question 5

A patient has a shallow medial-ankle ulcer, edema, and hemosiderin staining, without ischemic rest pain or signs of acute limb ischemia. Systolic pressures are 126 mmHg in the right arm and 140 mmHg in the left arm; in the affected leg, dorsalis pedis pressure is 86 mmHg and posterior tibial pressure is 98 mmHg. Using the ankle-brachial index and the WOCN compression pathway, which plan is appropriate for the wound clinician to consider?

Accepted Answer

ABI 0.70: consider modified light compression up to 30 mmHg, with close tolerance monitoring.

Answer

ABI 0.70: withhold all compression because this result indicates severe arterial insufficiency.

Answer

ABI 0.78: use standard high compression because the ulcer has predominantly venous features.

Answer

ABI 1.43: use standard high compression because the ankle pressure demonstrates adequate perfusion.

Question 6

At a preoperative visit for panniculectomy, a patient 18 months after Roux-en-Y gastric bypass reports fatigue and progressive tingling in both feet. Examination reveals reduced vibration sense. Hemoglobin is 10.2 g/dL and mean corpuscular volume is 111 fL. Which deficiency most coherently explains the hematologic and neurologic findings together?

Accepted Answer

Vitamin B12

Answer

Thiamine

Answer

Folate

Answer

Iron

Question 7

While receiving discharge instructions after blepharoplasty, a patient interrupts: 'Everything on the left suddenly looks dark.' The nurse finds new deep orbital pain, proptosis, and reduced vision in the left eye. Vital signs are stable. What takes priority?

Accepted Answer

Activate emergency assistance and obtain immediate surgical and ophthalmic assessment.

Answer

Apply cold compresses and reassess vision after the prescribed analgesic takes effect.

Answer

Arrange orbital CT before contacting the surgeon so that the bleeding site can be identified.

Answer

Instill lubricating drops and evaluate for corneal irritation once the drops have taken effect.

Question 8

A patient choosing between a DIEP flap and a pedicled TRAM flap asks, 'Is the DIEP just the same operation with a smaller scar?' Preserving abdominal strength is a major concern. Which explanation accurately distinguishes the procedures?

Accepted Answer

The DIEP preserves rectus muscle, although abdominal donor-site complications can still occur.

Answer

The DIEP uses tissue from a different donor site, so it avoids abdominal weakness and bulging.

Answer

The pedicled TRAM preserves rectus muscle because its original blood supply remains attached.

Answer

Both remove the same amount of rectus muscle; only the method of restoring blood flow differs.

Question 9

A full-thickness skin graft has just been secured over a well-vascularized nasal defect after skin-cancer excision. The bolster keeps the graft in close contact with the recipient bed. During the first postoperative hours, that contact primarily supports graft survival through:

Accepted Answer

Diffusion of fluid and nutrients from the recipient bed.

Answer

Uninterrupted circulation through a retained vascular pedicle.

Answer

Blood flow through surgically reconnected arterial anastomoses.

Answer

A mature capillary network already growing throughout the graft.

Question 10

During gluteal fat grafting, the circulating nurse observes several measures intended to prevent deep injection. Which observation directly confirms the injection-plane safeguard recommended by the joint plastic-surgery society safety statement?

Accepted Answer

Real-time ultrasound shows the cannula tip above the gluteal fascia while fat is being injected.

Answer

Preoperative ultrasound documented sufficient subcutaneous fat thickness at each planned injection site.

Answer

The surgeon can palpate the cannula tip through the skin before beginning each injection pass.

Answer

Aspiration through the cannula produces no blood before the surgeon injects each aliquot of fat.

Free CPSN Practice Questions

Domain 1: Head & neck 15% of exam

Question 1

Question 2

Domain 2: Breast 25% of exam

Question 3

Question 4

Question 5

Domain 3: Extremities 10% of exam

Question 6

Domain 4: Abdomen & trunk 15% of exam

Question 7

Domain 5: Surgical 30% of exam

Question 8

Question 9

Question 10

The rest of the CPSN blueprint

That's 10 of 1,030