NUR 201/NUR201 Final Exam V2 | Medical-
Surgical Nursing I Q&A with Rationale | Fortis
College
1. A nurse is caring for a patient in the immediate postoperative period who is experiencing a
sudden drop in blood pressure and an increased heart rate. What is the priority nursing
action?
A. Check the surgical dressing for hemorrhage.
B. Increase the IV fluid rate as prescribed.
C. Place the patient in the Trendelenburg position.
D. Notify the surgeon immediately.
Correct Answer: A
Explanation: In the immediate postoperative period, hypotension and tachycardia are
hallmark signs of hypovolemic shock due to bleeding. The nurse must first assess the
surgical site for active hemorrhage to identify the source of the problem. This assessment
provides critical data that the surgeon will need for further intervention.
2. Which of the following laboratory values should a nurse report to the provider for a patient
scheduled for surgery in two hours?
A. Sodium 138 mEq/L
B. Hemoglobin 14 g/dL
,C. Potassium 2.8 mEq/L
D. Glucose 110 mg/dL
Correct Answer: C
Explanation: A potassium level of 2.8 mEq/L indicates severe hypokalemia, which
significantly increases the risk of cardiac arrhythmias during anesthesia. Normal potassium
levels range from 3.5 to 5.0 mEq/L. The nurse must prioritize reporting this value to ensure
patient safety and potential stabilization before the procedure begins.
3. A patient with COPD is receiving oxygen therapy. Which of the following delivery methods
is most appropriate to provide a precise concentration of oxygen?
A. Nasal Cannula
B. Simple Face Mask
C. Non-rebreather Mask
D. Venturi Mask
Correct Answer: D
Explanation: The Venturi mask is specifically designed to deliver a precise and consistent
concentration of oxygen by using various sized adapters. This is vital for COPD patients
who require controlled oxygen levels to avoid suppressing their hypoxic drive to breathe.
Other methods like the nasal cannula or simple mask provide variable concentrations
depending on the patient’s respiratory rate.
, 4. A nurse is teaching a patient about the use of a metered-dose inhaler (MDI) with a spacer.
Which statement by the patient indicates understanding?
A. I will hold my breath for 10 seconds after inhaling the medication.
B. I should inhale as quickly as possible after pressing the canister.
C. I should wait 5 seconds between puffs if taking two puffs.
D. I will breathe out into the spacer before I press the canister.
Correct Answer: A
Explanation: Holding the breath for 10 seconds allows the medication to settle deep into
the airways for maximum efficacy. A spacer helps coordinate the timing and reduces the
amount of medication that hits the back of the throat. Inhaling slowly and waiting at least 1
minute between puffs are also standard teaching points for MDIs.
5. During the assessment of a patient with suspected hypocalcemia, the nurse inflates a blood
pressure cuff on the patient’s arm and observes carpal spasm. This is known as:
A. Chvostek’s sign
B. Homans’ sign
C. Trousseau’s sign
D. Kernig’s sign
Correct Answer: C
Surgical Nursing I Q&A with Rationale | Fortis
College
1. A nurse is caring for a patient in the immediate postoperative period who is experiencing a
sudden drop in blood pressure and an increased heart rate. What is the priority nursing
action?
A. Check the surgical dressing for hemorrhage.
B. Increase the IV fluid rate as prescribed.
C. Place the patient in the Trendelenburg position.
D. Notify the surgeon immediately.
Correct Answer: A
Explanation: In the immediate postoperative period, hypotension and tachycardia are
hallmark signs of hypovolemic shock due to bleeding. The nurse must first assess the
surgical site for active hemorrhage to identify the source of the problem. This assessment
provides critical data that the surgeon will need for further intervention.
2. Which of the following laboratory values should a nurse report to the provider for a patient
scheduled for surgery in two hours?
A. Sodium 138 mEq/L
B. Hemoglobin 14 g/dL
,C. Potassium 2.8 mEq/L
D. Glucose 110 mg/dL
Correct Answer: C
Explanation: A potassium level of 2.8 mEq/L indicates severe hypokalemia, which
significantly increases the risk of cardiac arrhythmias during anesthesia. Normal potassium
levels range from 3.5 to 5.0 mEq/L. The nurse must prioritize reporting this value to ensure
patient safety and potential stabilization before the procedure begins.
3. A patient with COPD is receiving oxygen therapy. Which of the following delivery methods
is most appropriate to provide a precise concentration of oxygen?
A. Nasal Cannula
B. Simple Face Mask
C. Non-rebreather Mask
D. Venturi Mask
Correct Answer: D
Explanation: The Venturi mask is specifically designed to deliver a precise and consistent
concentration of oxygen by using various sized adapters. This is vital for COPD patients
who require controlled oxygen levels to avoid suppressing their hypoxic drive to breathe.
Other methods like the nasal cannula or simple mask provide variable concentrations
depending on the patient’s respiratory rate.
, 4. A nurse is teaching a patient about the use of a metered-dose inhaler (MDI) with a spacer.
Which statement by the patient indicates understanding?
A. I will hold my breath for 10 seconds after inhaling the medication.
B. I should inhale as quickly as possible after pressing the canister.
C. I should wait 5 seconds between puffs if taking two puffs.
D. I will breathe out into the spacer before I press the canister.
Correct Answer: A
Explanation: Holding the breath for 10 seconds allows the medication to settle deep into
the airways for maximum efficacy. A spacer helps coordinate the timing and reduces the
amount of medication that hits the back of the throat. Inhaling slowly and waiting at least 1
minute between puffs are also standard teaching points for MDIs.
5. During the assessment of a patient with suspected hypocalcemia, the nurse inflates a blood
pressure cuff on the patient’s arm and observes carpal spasm. This is known as:
A. Chvostek’s sign
B. Homans’ sign
C. Trousseau’s sign
D. Kernig’s sign
Correct Answer: C
