NUR 201 Medical-Surgical Nursing I Exam 1 Prep Document
| 2026/2027 Edition | 250 Verified Questions
NUR 201 Exam 1 2026-2027 Questions and Answers Already Graded A+. 100% Verified Solutions | Updated Per
Latest Guidelines | Graded A+
This comprehensive test bank for NUR 201 Medical-Surgical Nursing I Exam 1 contains 250 verified
questions covering key concepts in perioperative care, fluid and electrolyte balance, pain management,
and common medical-surgical conditions. Designed to align with the Fortis curriculum and 2026/2027
academic standards, this resource provides rationales for correct answers and distractor explanations to
enhance understanding. Ideal for students seeking to reinforce knowledge and achieve a top score on
the exam.
Abstract:
This test bank for NUR 201 Medical-Surgical Nursing I Exam 1 comprises 250 meticulously verified questions that
reflect the core competencies required for safe and effective nursing practice. The content is organized to address
perioperative care, fluid and electrolyte management, pain assessment and intervention, and the nursing
management of patients with cardiovascular, respiratory, gastrointestinal, renal, endocrine, and neurological
disorders. Each question includes a detailed rationale for the correct answer and an analysis of incorrect options
to promote critical thinking. The material is aligned with the Fortis College curriculum and the 2026/2027
academic year, ensuring relevance to current clinical guidelines and NCLEX-RN test plans. This resource is
intended to serve as a primary study tool for students aiming to excel in their medical-surgical nursing
examination.
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-40 Preoperative assessment, Intraoperative care, 16%
Postoperative complications, Anesthesia
types, Surgical asepsis
Fluid and Electrolyte Balance 41-80 Fluid volume deficits/excess, Electrolyte 16%
imbalances (Na, K, Ca, Mg), Acid-base
disorders, IV therapy, TPN
Pain Management 81-110 Pain assessment scales, Opioid/non-opioid 12%
analgesics, PCA, Epidural analgesia,
Non-pharmacologic interventions
Cardiovascular Disorders 111-150 Hypertension, Heart failure, Coronary artery 16%
disease, Myocardial infarction, Cardiac
arrhythmias
Respiratory Disorders 151-180 COPD, Asthma, Pneumonia, Pulmonary 12%
embolism, Chest tube management
Gastrointestinal and Renal 181-210 Peptic ulcer disease, Bowel obstruction, 12%
Conditions Acute kidney injury, Chronic kidney
disease, Dialysis
Endocrine and Neurological 211-250 Diabetes mellitus, Diabetic ketoacidosis, 16%
Emergencies Hyperglycemic hyperosmolar state, Stroke,
Seizures
Page 1
,Q1. A patient with chronic kidney disease (stage 4) develops hyperkalemia (K+ 6.2 mEq/L). Which
intervention should the nurse question if prescribed?
A. Intravenous calcium gluconate
B. Sodium polystyrene sulfonate (Kayexalate) orally
C. Intravenous regular insulin and dextrose 50%
D. Intravenous normal saline with potassium chloride 20 mEq
Correct Answer: D. Intravenous normal saline with potassium chloride 20 mEq
Rationale: Intravenous normal saline with potassium chloride would worsen hyperkalemia by adding
more potassium. Calcium gluconate stabilizes cardiac membranes, Kayexalate removes potassium via the
gut, and insulin with dextrose shifts potassium intracellularly.
Why Wrong:
A - Calcium gluconate is indicated to protect the heart in severe hyperkalemia.
B - Sodium polystyrene sulfonate is a potassium-lowering resin used for chronic management.
C - Insulin and dextrose are standard emergency treatment to shift potassium into cells.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 52.
Q2. A post-operative patient has a urinary catheter and reports bladder pressure. The nurse notes
no urine output for 4 hours. What should the nurse do first?
A. Irrigate the catheter with 30 mL sterile normal saline
B. Assess for kinks in the tubing and ensure the drainage bag is below bladder level
C. Increase intravenous fluids to promote urine production
D. Notify the healthcare provider for possible catheter replacement
Correct Answer: B. Assess for kinks in the tubing and ensure the drainage bag is below bladder
level
Rationale: The most common cause of decreased urine output is mechanical obstruction (kinked tubing or
bag above bladder). The nurse should first check for correctable causes before more invasive
interventions.
Why Wrong:
A - Irrigation is not the first step; it may introduce infection if obstruction is not the issue.
C - Increasing fluids may be appropriate if the patient is hypovolemic, but assessment of output
should come first.
D - Notifying the provider is premature before performing a basic assessment.
Reference: Ignatavicius, D.D. & Workman, M.L. (2026). Medical-Surgical Nursing: Concepts for
Interprofessional Collaborative Care, 10th Ed., Ch. 17.
Page 2
,Q3. Which assessment finding is most indicative of a patient in the compensatory stage of
hypovolemic shock?
A. Mean arterial pressure (MAP) 55 mm Hg
B. Urine output 20 mL/hr
C. Heart rate 110 beats/min with normal blood pressure
D. Arterial pH 7.30
Correct Answer: C. Heart rate 110 beats/min with normal blood pressure
Rationale: In compensatory shock, the body activates sympathetic responses: tachycardia, increased
contractility, and vasoconstriction, which may maintain blood pressure. MAP <60, low urine output, and
acidosis indicate decompensation.
Why Wrong:
A - MAP <60 mm Hg is a sign of decompensated shock and inadequate perfusion.
B - Urine output <30 mL/hr indicates renal hypoperfusion, often seen in progressive shock.
D - Metabolic acidosis with pH <7.35 suggests lactic acidosis from anaerobic metabolism, a later
finding.
Reference: Urden, L.D. et al. (2026). Critical Care Nursing: Diagnosis and Management, 9th Ed., Ch.
15.
Q4. A patient receiving morphine via patient-controlled analgesia (PCA) has a respiratory rate of 8
breaths/min and is difficult to arouse. Which medication should the nurse administer?
A. Flumazenil 0.2 mg IV
B. Naloxone 0.4 mg IV
C. Naloxone 0.1 mg IV
D. Dantrolene 2.5 mg/kg IV
Correct Answer: C. Naloxone 0.1 mg IV
Rationale: Naloxone is the reversal agent for opioid-induced respiratory depression. For PCA patients,
low-dose naloxone (0.1 mg) is preferred to reverse respiratory depression without fully reversing
analgesia. Flumazenil reverses benzodiazepines; dantrolene treats malignant hyperthermia.
Why Wrong:
A - Flumazenil is for benzodiazepine overdose, not opioids.
B - 0.4 mg may cause acute withdrawal and severe pain; lower doses are recommended.
D - Dantrolene is for malignant hyperthermia, not opioid overdose.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 15.
Page 3
, Q5. A patient with a closed abdominal wound has a Penrose drain in place. Which nursing action is
correct?
A. Place a sterile safety pin through the drain to prevent retraction
B. Apply a sterile dressing over the drain and change it every shift
C. Cleanse from the drain site outward away from the wound
D. Advance the drain 1-2 cm daily and document the length
Correct Answer: A. Place a sterile safety pin through the drain to prevent retraction
Rationale: A Penrose drain is a passive, open drain that can retract into the wound. A sterile safety pin is
placed through the external portion to prevent retraction. The drain site is cleansed from clean to dirty
(wound outward), and dressing changes depend on drainage, not a fixed schedule.
Why Wrong:
B - Dressing changes should be as needed based on drainage, not routine every shift.
C - Cleansing should be from the wound outward (clean to dirty), not from drain site away.
D - Penrose drains are not advanced; they are shortened by cutting the external portion.
Reference: Perry, A.G. et al. (2026). Clinical Nursing Skills & Techniques, 10th Ed., Ch. 34.
Q6. A patient with a history of heart failure is admitted with pneumonia. The nurse notes jugular
venous distention, crackles, and an S3 heart sound. Which IV fluid order should the nurse question?
A. 0.9% sodium chloride at 100 mL/hr
B. Lactated Ringer's at 75 mL/hr
C. 0.45% sodium chloride at 50 mL/hr
D. D5W at 100 mL/hr
Correct Answer: A. 0.9% sodium chloride at 100 mL/hr
Rationale: The patient shows signs of fluid overload (JVD, crackles, S3). 0.9% normal saline is isotonic
and expands intravascular volume, worsening heart failure. Hypotonic fluids (0.45% NS) or D5W provide
less sodium load; lactated Ringer's is also isotonic but at a lower rate may be acceptable, but 0.9% NS at
100 mL/hr is most concerning.
Why Wrong:
B - Lactated Ringer's is isotonic but at 75 mL/hr, though still a concern, it is less aggressive than
option A.
C - 0.45% sodium chloride is hypotonic and less likely to cause fluid overload.
D - D5W is hypotonic once dextrose metabolizes, making it safer in this context.
Reference: Ignatavicius, D.D. & Workman, M.L. (2026). Medical-Surgical Nursing, 10th Ed., Ch. 13.
Page 4
| 2026/2027 Edition | 250 Verified Questions
NUR 201 Exam 1 2026-2027 Questions and Answers Already Graded A+. 100% Verified Solutions | Updated Per
Latest Guidelines | Graded A+
This comprehensive test bank for NUR 201 Medical-Surgical Nursing I Exam 1 contains 250 verified
questions covering key concepts in perioperative care, fluid and electrolyte balance, pain management,
and common medical-surgical conditions. Designed to align with the Fortis curriculum and 2026/2027
academic standards, this resource provides rationales for correct answers and distractor explanations to
enhance understanding. Ideal for students seeking to reinforce knowledge and achieve a top score on
the exam.
Abstract:
This test bank for NUR 201 Medical-Surgical Nursing I Exam 1 comprises 250 meticulously verified questions that
reflect the core competencies required for safe and effective nursing practice. The content is organized to address
perioperative care, fluid and electrolyte management, pain assessment and intervention, and the nursing
management of patients with cardiovascular, respiratory, gastrointestinal, renal, endocrine, and neurological
disorders. Each question includes a detailed rationale for the correct answer and an analysis of incorrect options
to promote critical thinking. The material is aligned with the Fortis College curriculum and the 2026/2027
academic year, ensuring relevance to current clinical guidelines and NCLEX-RN test plans. This resource is
intended to serve as a primary study tool for students aiming to excel in their medical-surgical nursing
examination.
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-40 Preoperative assessment, Intraoperative care, 16%
Postoperative complications, Anesthesia
types, Surgical asepsis
Fluid and Electrolyte Balance 41-80 Fluid volume deficits/excess, Electrolyte 16%
imbalances (Na, K, Ca, Mg), Acid-base
disorders, IV therapy, TPN
Pain Management 81-110 Pain assessment scales, Opioid/non-opioid 12%
analgesics, PCA, Epidural analgesia,
Non-pharmacologic interventions
Cardiovascular Disorders 111-150 Hypertension, Heart failure, Coronary artery 16%
disease, Myocardial infarction, Cardiac
arrhythmias
Respiratory Disorders 151-180 COPD, Asthma, Pneumonia, Pulmonary 12%
embolism, Chest tube management
Gastrointestinal and Renal 181-210 Peptic ulcer disease, Bowel obstruction, 12%
Conditions Acute kidney injury, Chronic kidney
disease, Dialysis
Endocrine and Neurological 211-250 Diabetes mellitus, Diabetic ketoacidosis, 16%
Emergencies Hyperglycemic hyperosmolar state, Stroke,
Seizures
Page 1
,Q1. A patient with chronic kidney disease (stage 4) develops hyperkalemia (K+ 6.2 mEq/L). Which
intervention should the nurse question if prescribed?
A. Intravenous calcium gluconate
B. Sodium polystyrene sulfonate (Kayexalate) orally
C. Intravenous regular insulin and dextrose 50%
D. Intravenous normal saline with potassium chloride 20 mEq
Correct Answer: D. Intravenous normal saline with potassium chloride 20 mEq
Rationale: Intravenous normal saline with potassium chloride would worsen hyperkalemia by adding
more potassium. Calcium gluconate stabilizes cardiac membranes, Kayexalate removes potassium via the
gut, and insulin with dextrose shifts potassium intracellularly.
Why Wrong:
A - Calcium gluconate is indicated to protect the heart in severe hyperkalemia.
B - Sodium polystyrene sulfonate is a potassium-lowering resin used for chronic management.
C - Insulin and dextrose are standard emergency treatment to shift potassium into cells.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 52.
Q2. A post-operative patient has a urinary catheter and reports bladder pressure. The nurse notes
no urine output for 4 hours. What should the nurse do first?
A. Irrigate the catheter with 30 mL sterile normal saline
B. Assess for kinks in the tubing and ensure the drainage bag is below bladder level
C. Increase intravenous fluids to promote urine production
D. Notify the healthcare provider for possible catheter replacement
Correct Answer: B. Assess for kinks in the tubing and ensure the drainage bag is below bladder
level
Rationale: The most common cause of decreased urine output is mechanical obstruction (kinked tubing or
bag above bladder). The nurse should first check for correctable causes before more invasive
interventions.
Why Wrong:
A - Irrigation is not the first step; it may introduce infection if obstruction is not the issue.
C - Increasing fluids may be appropriate if the patient is hypovolemic, but assessment of output
should come first.
D - Notifying the provider is premature before performing a basic assessment.
Reference: Ignatavicius, D.D. & Workman, M.L. (2026). Medical-Surgical Nursing: Concepts for
Interprofessional Collaborative Care, 10th Ed., Ch. 17.
Page 2
,Q3. Which assessment finding is most indicative of a patient in the compensatory stage of
hypovolemic shock?
A. Mean arterial pressure (MAP) 55 mm Hg
B. Urine output 20 mL/hr
C. Heart rate 110 beats/min with normal blood pressure
D. Arterial pH 7.30
Correct Answer: C. Heart rate 110 beats/min with normal blood pressure
Rationale: In compensatory shock, the body activates sympathetic responses: tachycardia, increased
contractility, and vasoconstriction, which may maintain blood pressure. MAP <60, low urine output, and
acidosis indicate decompensation.
Why Wrong:
A - MAP <60 mm Hg is a sign of decompensated shock and inadequate perfusion.
B - Urine output <30 mL/hr indicates renal hypoperfusion, often seen in progressive shock.
D - Metabolic acidosis with pH <7.35 suggests lactic acidosis from anaerobic metabolism, a later
finding.
Reference: Urden, L.D. et al. (2026). Critical Care Nursing: Diagnosis and Management, 9th Ed., Ch.
15.
Q4. A patient receiving morphine via patient-controlled analgesia (PCA) has a respiratory rate of 8
breaths/min and is difficult to arouse. Which medication should the nurse administer?
A. Flumazenil 0.2 mg IV
B. Naloxone 0.4 mg IV
C. Naloxone 0.1 mg IV
D. Dantrolene 2.5 mg/kg IV
Correct Answer: C. Naloxone 0.1 mg IV
Rationale: Naloxone is the reversal agent for opioid-induced respiratory depression. For PCA patients,
low-dose naloxone (0.1 mg) is preferred to reverse respiratory depression without fully reversing
analgesia. Flumazenil reverses benzodiazepines; dantrolene treats malignant hyperthermia.
Why Wrong:
A - Flumazenil is for benzodiazepine overdose, not opioids.
B - 0.4 mg may cause acute withdrawal and severe pain; lower doses are recommended.
D - Dantrolene is for malignant hyperthermia, not opioid overdose.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 15.
Page 3
, Q5. A patient with a closed abdominal wound has a Penrose drain in place. Which nursing action is
correct?
A. Place a sterile safety pin through the drain to prevent retraction
B. Apply a sterile dressing over the drain and change it every shift
C. Cleanse from the drain site outward away from the wound
D. Advance the drain 1-2 cm daily and document the length
Correct Answer: A. Place a sterile safety pin through the drain to prevent retraction
Rationale: A Penrose drain is a passive, open drain that can retract into the wound. A sterile safety pin is
placed through the external portion to prevent retraction. The drain site is cleansed from clean to dirty
(wound outward), and dressing changes depend on drainage, not a fixed schedule.
Why Wrong:
B - Dressing changes should be as needed based on drainage, not routine every shift.
C - Cleansing should be from the wound outward (clean to dirty), not from drain site away.
D - Penrose drains are not advanced; they are shortened by cutting the external portion.
Reference: Perry, A.G. et al. (2026). Clinical Nursing Skills & Techniques, 10th Ed., Ch. 34.
Q6. A patient with a history of heart failure is admitted with pneumonia. The nurse notes jugular
venous distention, crackles, and an S3 heart sound. Which IV fluid order should the nurse question?
A. 0.9% sodium chloride at 100 mL/hr
B. Lactated Ringer's at 75 mL/hr
C. 0.45% sodium chloride at 50 mL/hr
D. D5W at 100 mL/hr
Correct Answer: A. 0.9% sodium chloride at 100 mL/hr
Rationale: The patient shows signs of fluid overload (JVD, crackles, S3). 0.9% normal saline is isotonic
and expands intravascular volume, worsening heart failure. Hypotonic fluids (0.45% NS) or D5W provide
less sodium load; lactated Ringer's is also isotonic but at a lower rate may be acceptable, but 0.9% NS at
100 mL/hr is most concerning.
Why Wrong:
B - Lactated Ringer's is isotonic but at 75 mL/hr, though still a concern, it is less aggressive than
option A.
C - 0.45% sodium chloride is hypotonic and less likely to cause fluid overload.
D - D5W is hypotonic once dextrose metabolizes, making it safer in this context.
Reference: Ignatavicius, D.D. & Workman, M.L. (2026). Medical-Surgical Nursing, 10th Ed., Ch. 13.
Page 4
