2026/2027
NUR 155 Exam 3 Comprehensive
Study Guide and Practice Review
Workbook (2026/2027 Edition) for
Galen College of Nursing Success
Question 1:
A nurse is assessing a postoperative patient and notes wound dehiscence with
increased drainage and visible underlying tissue. What is the most appropriate
immediate nursing action?
A. Apply dry sterile gauze and document findings
B. Apply a sterile normal saline–soaked dressing to the wound
C. Remove sutures to relieve tension
D. Leave the wound open to air for assessment
Correct Answer: B. Apply a sterile normal saline–soaked dressing to the wound
Rationale:
When wound dehiscence occurs, the priority is to protect exposed tissues and
maintain a moist sterile environment. A saline-soaked sterile dressing prevents tissue
drying and contamination while awaiting further medical management. Dry dressings
(A) can adhere to tissues and worsen injury. Removing sutures (C) is outside nursing
scope and unsafe. Leaving the wound open (D) increases infection risk and tissue
desiccation.
Question 2:
A client scheduled for spinal surgery demonstrates understanding of postoperative
care when stating:
A. “I will avoid turning in bed after surgery.”
B. “I will remain in bed for two weeks after surgery.”
C. “I will show you how I will turn after surgery.”
D. “I will not need any pain medication after surgery.”
Correct Answer: C. “I will show you how I will turn after surgery.”
Rationale:
Correct understanding of preoperative teaching is shown when the client demonstrates
engagement in postoperative mobility techniques. Safe turning is essential after spinal
surgery. Avoiding turning (A) increases complications such as pressure injuries.
,2026/2027
Prolonged bed rest (B) is incorrect and increases risk of DVT. Refusal of pain
medication (D) indicates misunderstanding of postoperative pain control needs.
Question 3:
Which method is most appropriate for assessing pain in a postoperative client with
advanced cognitive impairment?
A. Numeric pain scale
B. Self-report only
C. Observation of facial expressions and body language
D. Blood pressure alone
Correct Answer: C. Observation of facial expressions and body language
Rationale:
Clients with severe cognitive impairment may not reliably self-report pain. Behavioral
indicators such as facial expression, guarding, restlessness, and consolability are most
accurate. Numeric scales (A) require cognition. Self-report only (B) may be unreliable.
Vital signs alone (D) are nonspecific.
Question 4:
A client with diabetes reports burning, sharp pain in both lower extremities. The nurse
recognizes this as:
A. Referred pain
B. Neuropathic pain
C. Somatic pain
D. Psychogenic pain
Correct Answer: B. Neuropathic pain
Rationale:
Neuropathic pain results from nerve damage, commonly seen in diabetic neuropathy.
It is often described as burning or shooting. Referred pain (A) originates elsewhere.
Somatic pain (C) is tissue-related. Psychogenic pain (D) is not due to physiological
nerve damage.
Question 5:
Which client finding requires immediate notification of the healthcare provider before
surgery?
,2026/2027
A. Mild anxiety about surgery
B. Family history of malignant hyperthermia
C. Controlled hypertension
D. Slight fever after fasting
Correct Answer: B. Family history of malignant hyperthermia
Rationale:
Malignant hyperthermia is a life-threatening anesthesia complication triggered by
genetic predisposition. A family history must be reported immediately. Anxiety (A) is
expected. Controlled hypertension (C) is usually manageable. Mild fever (D) may
require evaluation but is not as critical preoperatively.
Question 6:
Which nursing intervention best reduces the risk of deep vein thrombosis (DVT) in a
postoperative client?
A. Restricting movement to conserve energy
B. Encouraging frequent early ambulation
C. Applying cold compresses to legs
D. Keeping the client in a supine position
Correct Answer: B. Encouraging frequent early ambulation
Rationale:
Early mobilization improves venous circulation and prevents clot formation.
Immobilization (A and D) increases DVT risk. Cold therapy (C) is not a preventive
measure for thrombosis.
Question 7:
A client who had femoral artery catheterization reports numbness in the right leg.
What is the nurse’s priority action?
A. Encourage leg movement
B. Document the finding
C. Assess distal pulses and notify provider
D. Apply warm compress
Correct Answer: C. Assess distal pulses and notify provider
Rationale:
Numbness may indicate impaired circulation or arterial occlusion. The nurse must
assess perfusion and notify the provider immediately. Encouraging movement (A)
may worsen injury. Documentation alone (B) delays intervention. Warm compress (D)
is inappropriate for possible vascular compromise.
, 2026/2027
Question 8:
Which dietary factor indicates misunderstanding of DVT risk teaching?
A. Smoking
B. Oral contraceptives
C. High calcium intake
D. Immobility
Correct Answer: C. High calcium intake
Rationale:
High calcium intake is not a risk factor for DVT. True risk factors include smoking,
immobility, and oral contraceptives. The incorrect selection reflects misunderstanding.
Question 9:
Which assessment findings require immediate attention in a postoperative client?
(Select all that apply)
1. Shortness of breath
2. Back pain
3. Temperature elevation
4. Hyperlipidemia history
5. Asthma history
6. Increased respiratory rate
7. Hypotension
Correct Answer: 1, 3, 6, 7
Rationale:
Shortness of breath, fever, tachypnea, and hypotension may indicate serious
complications such as infection, pulmonary embolism, or shock. Back pain and
history factors are not immediate threats.
Question 10:
A client with left-sided heart failure is most likely to develop which additional
symptom?
A. Confusion
B. Bradycardia
C. Hypothermia
D. Polyuria
NUR 155 Exam 3 Comprehensive
Study Guide and Practice Review
Workbook (2026/2027 Edition) for
Galen College of Nursing Success
Question 1:
A nurse is assessing a postoperative patient and notes wound dehiscence with
increased drainage and visible underlying tissue. What is the most appropriate
immediate nursing action?
A. Apply dry sterile gauze and document findings
B. Apply a sterile normal saline–soaked dressing to the wound
C. Remove sutures to relieve tension
D. Leave the wound open to air for assessment
Correct Answer: B. Apply a sterile normal saline–soaked dressing to the wound
Rationale:
When wound dehiscence occurs, the priority is to protect exposed tissues and
maintain a moist sterile environment. A saline-soaked sterile dressing prevents tissue
drying and contamination while awaiting further medical management. Dry dressings
(A) can adhere to tissues and worsen injury. Removing sutures (C) is outside nursing
scope and unsafe. Leaving the wound open (D) increases infection risk and tissue
desiccation.
Question 2:
A client scheduled for spinal surgery demonstrates understanding of postoperative
care when stating:
A. “I will avoid turning in bed after surgery.”
B. “I will remain in bed for two weeks after surgery.”
C. “I will show you how I will turn after surgery.”
D. “I will not need any pain medication after surgery.”
Correct Answer: C. “I will show you how I will turn after surgery.”
Rationale:
Correct understanding of preoperative teaching is shown when the client demonstrates
engagement in postoperative mobility techniques. Safe turning is essential after spinal
surgery. Avoiding turning (A) increases complications such as pressure injuries.
,2026/2027
Prolonged bed rest (B) is incorrect and increases risk of DVT. Refusal of pain
medication (D) indicates misunderstanding of postoperative pain control needs.
Question 3:
Which method is most appropriate for assessing pain in a postoperative client with
advanced cognitive impairment?
A. Numeric pain scale
B. Self-report only
C. Observation of facial expressions and body language
D. Blood pressure alone
Correct Answer: C. Observation of facial expressions and body language
Rationale:
Clients with severe cognitive impairment may not reliably self-report pain. Behavioral
indicators such as facial expression, guarding, restlessness, and consolability are most
accurate. Numeric scales (A) require cognition. Self-report only (B) may be unreliable.
Vital signs alone (D) are nonspecific.
Question 4:
A client with diabetes reports burning, sharp pain in both lower extremities. The nurse
recognizes this as:
A. Referred pain
B. Neuropathic pain
C. Somatic pain
D. Psychogenic pain
Correct Answer: B. Neuropathic pain
Rationale:
Neuropathic pain results from nerve damage, commonly seen in diabetic neuropathy.
It is often described as burning or shooting. Referred pain (A) originates elsewhere.
Somatic pain (C) is tissue-related. Psychogenic pain (D) is not due to physiological
nerve damage.
Question 5:
Which client finding requires immediate notification of the healthcare provider before
surgery?
,2026/2027
A. Mild anxiety about surgery
B. Family history of malignant hyperthermia
C. Controlled hypertension
D. Slight fever after fasting
Correct Answer: B. Family history of malignant hyperthermia
Rationale:
Malignant hyperthermia is a life-threatening anesthesia complication triggered by
genetic predisposition. A family history must be reported immediately. Anxiety (A) is
expected. Controlled hypertension (C) is usually manageable. Mild fever (D) may
require evaluation but is not as critical preoperatively.
Question 6:
Which nursing intervention best reduces the risk of deep vein thrombosis (DVT) in a
postoperative client?
A. Restricting movement to conserve energy
B. Encouraging frequent early ambulation
C. Applying cold compresses to legs
D. Keeping the client in a supine position
Correct Answer: B. Encouraging frequent early ambulation
Rationale:
Early mobilization improves venous circulation and prevents clot formation.
Immobilization (A and D) increases DVT risk. Cold therapy (C) is not a preventive
measure for thrombosis.
Question 7:
A client who had femoral artery catheterization reports numbness in the right leg.
What is the nurse’s priority action?
A. Encourage leg movement
B. Document the finding
C. Assess distal pulses and notify provider
D. Apply warm compress
Correct Answer: C. Assess distal pulses and notify provider
Rationale:
Numbness may indicate impaired circulation or arterial occlusion. The nurse must
assess perfusion and notify the provider immediately. Encouraging movement (A)
may worsen injury. Documentation alone (B) delays intervention. Warm compress (D)
is inappropriate for possible vascular compromise.
, 2026/2027
Question 8:
Which dietary factor indicates misunderstanding of DVT risk teaching?
A. Smoking
B. Oral contraceptives
C. High calcium intake
D. Immobility
Correct Answer: C. High calcium intake
Rationale:
High calcium intake is not a risk factor for DVT. True risk factors include smoking,
immobility, and oral contraceptives. The incorrect selection reflects misunderstanding.
Question 9:
Which assessment findings require immediate attention in a postoperative client?
(Select all that apply)
1. Shortness of breath
2. Back pain
3. Temperature elevation
4. Hyperlipidemia history
5. Asthma history
6. Increased respiratory rate
7. Hypotension
Correct Answer: 1, 3, 6, 7
Rationale:
Shortness of breath, fever, tachypnea, and hypotension may indicate serious
complications such as infection, pulmonary embolism, or shock. Back pain and
history factors are not immediate threats.
Question 10:
A client with left-sided heart failure is most likely to develop which additional
symptom?
A. Confusion
B. Bradycardia
C. Hypothermia
D. Polyuria
