NUR 242 MED SURG FINAL EXAM
GALEN COLLEGE OF NURSING | COMPREHENSIVE
CUMULATIVE FINAL COMPLETE 200 QUESTIONS
WITH CORRECT ANSWERS AND RATIONALES ALREADY
GRADED A+
SECTION A: PERIOPERATIVE AND SURGICAL CARE (Questions 1–25)
1. A client is scheduled for surgery and asks the nurse why they cannot eat or
drink before the procedure. The nurse's best response is:
A. "It prevents dehydration during surgery."
B. "It reduces the risk of aspiration during anesthesia." ✔
C. "It keeps the stomach empty for better surgical visualization."
D. "It prevents nausea after surgery."
Rationale: NPO status reduces gastric volume and acidity, minimizing the risk of
aspiration of gastric contents into the lungs during anesthesia induction.
Aspiration pneumonitis is a serious complication.
2. A client is being prepared for surgery and reports taking an herbal supplement,
ginkgo biloba. The nurse's priority action is to:
A. Document the finding and proceed with surgery
B. Instruct the client to stop taking the supplement immediately
C. Notify the surgeon and anesthesia provider because ginkgo increases bleeding
risk ✔
D. Tell the client it is safe to continue the supplement
Rationale: Ginkgo biloba has antiplatelet effects and can increase bleeding risk
during and after surgery. The surgeon and anesthesia provider must be notified.
3. A client is in the PACU after surgery and has an oxygen saturation of 88% on
room air. The nurse's priority action is to:
A. Apply oxygen and assess the client's airway and breathing ✔
B. Call the rapid response team
C. Administer naloxone
1
,D. Place the client in Trendelenburg position
Rationale: An SpO2 of 88% indicates hypoxemia. The priority is to apply oxygen,
position the client to optimize ventilation, and assess for airway obstruction or
hypoventilation.
4. A client is 6 hours post-surgery and has not voided. The nurse palpates a
distended bladder. The priority action is to:
A. Encourage oral fluid intake
B. Insert a Foley catheter
C. Perform a bladder scan to assess urinary retention ✔
D. Wait 2 more hours and reassess
Rationale: Urinary retention is common postoperatively. A bladder scan should be
performed to assess urine volume. If significant (>400-600 mL), catheterization
may be needed.
5. The nurse is assessing a client's surgical wound 5 days postoperatively and
notes wound edges separating with visible bowel protruding. The nurse's priority
action is to:
A. Apply a dry sterile dressing and notify the provider
B. Place sterile saline-soaked gauze over the eviscerated bowel and notify the
provider immediately ✔
C. Push the bowel back into the abdominal cavity
D. Place the client in high Fowler's position
Rationale: This is a wound evisceration, a surgical emergency. The nurse should
cover the exposed bowel with sterile saline-soaked gauze, keep the client supine
with knees bent, and notify the provider immediately.
6. A client is being discharged after surgery with a Jackson-Pratt drain. Which
statement indicates the client understands the teaching?
A. "I can shower with the drain in place if I cover it with a waterproof dressing." ✔
B. "I should empty the drain only when it is full."
C. "I should keep the drain at the same level as my incision."
2
,D. "I should not measure the drainage."
Rationale: Showering with a drain in place is permitted if covered with a
waterproof dressing. The drain should be emptied when half full, kept below the
incision level, and output measured.
7. The nurse is caring for a client who received spinal anesthesia. Which
complication is specific to this type of anesthesia?
A. Nausea and vomiting
B. Post-dural puncture headache ✔
C. Urinary retention
D. Sore throat
Rationale: Post-dural puncture headache (spinal headache) is a complication of
spinal anesthesia caused by leakage of cerebrospinal fluid through the dural
puncture site.
8. A client with a history of obstructive sleep apnea is scheduled for surgery. The
nurse should prioritize which intervention?
A. Administer a full dose of preoperative sedatives
B. Position the client supine during transport
C. Avoid the use of opioids in the postoperative period if possible and monitor
respiratory status closely ✔
D. Encourage a high-carbohydrate meal before surgery
Rationale: Clients with OSA are at increased risk for respiratory depression and
airway obstruction, especially with sedatives and opioids. The nurse should
advocate for multimodal analgesia and monitor respiratory status.
9. The nurse is monitoring a client in the PACU after general anesthesia. Which
assessment finding requires immediate notification of the provider?
A. Heart rate of 88 beats per minute
B. Blood pressure 110/70 mmHg
C. Respiratory rate of 8 breaths per minute ✔
D. Temperature of 37.0°C
3
, Rationale: A respiratory rate of 8 indicates respiratory depression, which can
result from residual anesthetic effects or opioid administration. This requires
immediate intervention.
10. A client is scheduled for a laparoscopic cholecystectomy. The nurse explains
that this procedure involves:
A. A large abdominal incision
B. Multiple small incisions and faster recovery compared to open surgery ✔
C. Always more complicated than open surgery
D. A 2-week hospital stay
Rationale: Laparoscopic cholecystectomy uses small incisions (ports) and a
camera, resulting in less pain, shorter hospital stays, and faster recovery
compared to open surgery.
11. The nurse is assessing a client with a surgical wound and observes well-
approximated edges with no redness or drainage. The nurse documents this as:
A. Wound dehiscence
B. Wound infection
C. Normal wound healing ✔
D. Wound evisceration
Rationale: Well-approximated wound edges with no redness, warmth, swelling, or
drainage indicate normal healing. Dehiscence is separation of wound layers;
evisceration is protrusion of organs.
12. A client is 2 days post-surgery and develops a fever, chest pain, and
productive cough with green sputum. The nurse suspects:
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia ✔
D. Wound infection
4
GALEN COLLEGE OF NURSING | COMPREHENSIVE
CUMULATIVE FINAL COMPLETE 200 QUESTIONS
WITH CORRECT ANSWERS AND RATIONALES ALREADY
GRADED A+
SECTION A: PERIOPERATIVE AND SURGICAL CARE (Questions 1–25)
1. A client is scheduled for surgery and asks the nurse why they cannot eat or
drink before the procedure. The nurse's best response is:
A. "It prevents dehydration during surgery."
B. "It reduces the risk of aspiration during anesthesia." ✔
C. "It keeps the stomach empty for better surgical visualization."
D. "It prevents nausea after surgery."
Rationale: NPO status reduces gastric volume and acidity, minimizing the risk of
aspiration of gastric contents into the lungs during anesthesia induction.
Aspiration pneumonitis is a serious complication.
2. A client is being prepared for surgery and reports taking an herbal supplement,
ginkgo biloba. The nurse's priority action is to:
A. Document the finding and proceed with surgery
B. Instruct the client to stop taking the supplement immediately
C. Notify the surgeon and anesthesia provider because ginkgo increases bleeding
risk ✔
D. Tell the client it is safe to continue the supplement
Rationale: Ginkgo biloba has antiplatelet effects and can increase bleeding risk
during and after surgery. The surgeon and anesthesia provider must be notified.
3. A client is in the PACU after surgery and has an oxygen saturation of 88% on
room air. The nurse's priority action is to:
A. Apply oxygen and assess the client's airway and breathing ✔
B. Call the rapid response team
C. Administer naloxone
1
,D. Place the client in Trendelenburg position
Rationale: An SpO2 of 88% indicates hypoxemia. The priority is to apply oxygen,
position the client to optimize ventilation, and assess for airway obstruction or
hypoventilation.
4. A client is 6 hours post-surgery and has not voided. The nurse palpates a
distended bladder. The priority action is to:
A. Encourage oral fluid intake
B. Insert a Foley catheter
C. Perform a bladder scan to assess urinary retention ✔
D. Wait 2 more hours and reassess
Rationale: Urinary retention is common postoperatively. A bladder scan should be
performed to assess urine volume. If significant (>400-600 mL), catheterization
may be needed.
5. The nurse is assessing a client's surgical wound 5 days postoperatively and
notes wound edges separating with visible bowel protruding. The nurse's priority
action is to:
A. Apply a dry sterile dressing and notify the provider
B. Place sterile saline-soaked gauze over the eviscerated bowel and notify the
provider immediately ✔
C. Push the bowel back into the abdominal cavity
D. Place the client in high Fowler's position
Rationale: This is a wound evisceration, a surgical emergency. The nurse should
cover the exposed bowel with sterile saline-soaked gauze, keep the client supine
with knees bent, and notify the provider immediately.
6. A client is being discharged after surgery with a Jackson-Pratt drain. Which
statement indicates the client understands the teaching?
A. "I can shower with the drain in place if I cover it with a waterproof dressing." ✔
B. "I should empty the drain only when it is full."
C. "I should keep the drain at the same level as my incision."
2
,D. "I should not measure the drainage."
Rationale: Showering with a drain in place is permitted if covered with a
waterproof dressing. The drain should be emptied when half full, kept below the
incision level, and output measured.
7. The nurse is caring for a client who received spinal anesthesia. Which
complication is specific to this type of anesthesia?
A. Nausea and vomiting
B. Post-dural puncture headache ✔
C. Urinary retention
D. Sore throat
Rationale: Post-dural puncture headache (spinal headache) is a complication of
spinal anesthesia caused by leakage of cerebrospinal fluid through the dural
puncture site.
8. A client with a history of obstructive sleep apnea is scheduled for surgery. The
nurse should prioritize which intervention?
A. Administer a full dose of preoperative sedatives
B. Position the client supine during transport
C. Avoid the use of opioids in the postoperative period if possible and monitor
respiratory status closely ✔
D. Encourage a high-carbohydrate meal before surgery
Rationale: Clients with OSA are at increased risk for respiratory depression and
airway obstruction, especially with sedatives and opioids. The nurse should
advocate for multimodal analgesia and monitor respiratory status.
9. The nurse is monitoring a client in the PACU after general anesthesia. Which
assessment finding requires immediate notification of the provider?
A. Heart rate of 88 beats per minute
B. Blood pressure 110/70 mmHg
C. Respiratory rate of 8 breaths per minute ✔
D. Temperature of 37.0°C
3
, Rationale: A respiratory rate of 8 indicates respiratory depression, which can
result from residual anesthetic effects or opioid administration. This requires
immediate intervention.
10. A client is scheduled for a laparoscopic cholecystectomy. The nurse explains
that this procedure involves:
A. A large abdominal incision
B. Multiple small incisions and faster recovery compared to open surgery ✔
C. Always more complicated than open surgery
D. A 2-week hospital stay
Rationale: Laparoscopic cholecystectomy uses small incisions (ports) and a
camera, resulting in less pain, shorter hospital stays, and faster recovery
compared to open surgery.
11. The nurse is assessing a client with a surgical wound and observes well-
approximated edges with no redness or drainage. The nurse documents this as:
A. Wound dehiscence
B. Wound infection
C. Normal wound healing ✔
D. Wound evisceration
Rationale: Well-approximated wound edges with no redness, warmth, swelling, or
drainage indicate normal healing. Dehiscence is separation of wound layers;
evisceration is protrusion of organs.
12. A client is 2 days post-surgery and develops a fever, chest pain, and
productive cough with green sputum. The nurse suspects:
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia ✔
D. Wound infection
4
