NUR242/NUR 242 Medical-Surgical Nursing Exam
Blueprint Replica Actual 2026/2027 with Detailed
Rationales | 100% Verified | Pass Guaranteed
SECTION 1: PERIOPERATIVE NURSING & FLUID/ELECTROLYTE
BALANCE (Questions 1–20)
Q1: A patient is scheduled for an elective cholecystectomy and reports taking warfarin
daily. What is the nurse's priority preoperative action?
A. Instruct the patient to continue the warfarin until the morning of surgery
B. Notify the surgeon immediately about the anticoagulant use [CORRECT]
C. Administer vitamin K prophylactically before surgery
D. Document the medication and proceed with standard preoperative teaching
Correct Answer: B
Rationale: Correct because warfarin increases bleeding risk during surgery and requires
specific management, including possible bridging therapy or discontinuation timing
based on the surgeon's protocol. Priority is communicating this information to the
surgical team for collaborative decision-making.
Q2: During the immediate postoperative period, a patient exhibits shallow breathing at 8
breaths/minute with an oxygen saturation of 89%. What is the nurse's first priority
intervention?
,A. Administer prescribed opioid analgesic
B. Apply supplemental oxygen via nasal cannula at 2 L/min
C. Encourage the patient to take deep breaths and use the incentive spirometer
D. Position the patient in high-Fowler's and stimulate to take deep breaths [CORRECT]
Correct Answer: D
Rationale: Correct because the patient is demonstrating hypoventilation with
hypoxemia; stimulating deep breathing and repositioning addresses airway clearance
and ventilation as the immediate priority before oxygen administration per ABC
protocol.
Q3: A postoperative patient on the second day after abdominal surgery reports sudden
severe pain at the incision site and the nurse notes serosanguineous drainage on the
dressing. Upon inspection, the nurse observes bowel protruding through the incision.
What is the priority nursing action?
A. Apply a sterile gauze dressing soaked in normal saline and notify the surgeon
[CORRECT]
B. Push the protruding bowel back into the abdominal cavity
C. Cover the wound with a dry sterile dressing and place the patient supine
D. Administer IV opioid analgesic and prepare for emergency surgery
Correct Answer: A
Rationale: Correct because this indicates wound dehiscence with evisceration; the
nurse must cover the exposed bowel with a sterile saline-moistened dressing to prevent
tissue desiccation and infection while immediately notifying the surgeon for emergency
repair.
Q4: A patient with a serum potassium level of 2.8 mEq/L is receiving IV potassium
chloride. Which nursing action is essential during administration?
,A. Administer via gravity drip without a pump to prevent infiltration
B. Administer via peripheral IV at a rate not exceeding 10 mEq/hour [CORRECT]
C. Mix potassium in dextrose 5% solution to enhance cellular uptake
D. Administer IV push for rapid correction of hypokalemia
Correct Answer: B
Rationale: Correct because IV potassium must never be given as a bolus due to risk of
cardiac arrest; peripheral administration should not exceed 10 mEq/hour, and
continuous cardiac monitoring is required during infusion.
Q5: A patient with metabolic acidosis has the following arterial blood gas results: pH
7.28, PaCO2 38 mmHg, HCO3 16 mEq/L. What is the primary compensatory mechanism
the nurse should anticipate?
A. Hyperventilation to decrease PaCO2
B. Hypoventilation to increase PaCO2
C. Renal retention of bicarbonate
D. Renal excretion of hydrogen ions [CORRECT]
Correct Answer: D
Rationale: Correct because in metabolic acidosis, the kidneys compensate by increasing
hydrogen ion excretion and generating new bicarbonate; respiratory compensation
through hyperventilation occurs but is not the primary renal compensatory mechanism
described.
Q6: A patient in the PACU after general anesthesia is shivering uncontrollably. The nurse
notes a core temperature of 35.2°C (95.4°F). What is the most appropriate nursing
intervention?
A. Apply ice packs to reduce metabolic demand
, B. Apply warm blankets and use a forced-air warming device [CORRECT]
C. Administer prescribed antipyretic medication
D. Increase IV fluid rate to improve circulation
Correct Answer: B
Rationale: Correct because postoperative shivering indicates hypothermia from
anesthesia-induced vasodilation and impaired thermoregulation; active rewarming with
forced-air warming devices and warm blankets is the priority intervention.
Q7: A patient with heart failure is receiving furosemide 40 mg IV twice daily. The nurse
should monitor for which electrolyte imbalance most commonly associated with this
therapy?
A. Hyperkalemia
B. Hypokalemia [CORRECT]
C. Hypernatremia
D. Hypercalcemia
Correct Answer: B
Rationale: Correct because furosemide is a loop diuretic that inhibits sodium and
chloride reabsorption in the ascending loop of Henle, causing increased potassium
excretion in urine and placing the patient at high risk for hypokalemia.
Q8: During preoperative assessment, a patient reports a history of malignant
hyperthermia in a sibling. What is the nurse's priority action?
A. Document the family history and proceed with standard preoperative preparation
B. Ensure dantrolene is available and communicate risk to the anesthesia team
[CORRECT]
C. Cancel the surgery until genetic testing can be completed
D. Administer prophylactic dantrolene preoperatively
Blueprint Replica Actual 2026/2027 with Detailed
Rationales | 100% Verified | Pass Guaranteed
SECTION 1: PERIOPERATIVE NURSING & FLUID/ELECTROLYTE
BALANCE (Questions 1–20)
Q1: A patient is scheduled for an elective cholecystectomy and reports taking warfarin
daily. What is the nurse's priority preoperative action?
A. Instruct the patient to continue the warfarin until the morning of surgery
B. Notify the surgeon immediately about the anticoagulant use [CORRECT]
C. Administer vitamin K prophylactically before surgery
D. Document the medication and proceed with standard preoperative teaching
Correct Answer: B
Rationale: Correct because warfarin increases bleeding risk during surgery and requires
specific management, including possible bridging therapy or discontinuation timing
based on the surgeon's protocol. Priority is communicating this information to the
surgical team for collaborative decision-making.
Q2: During the immediate postoperative period, a patient exhibits shallow breathing at 8
breaths/minute with an oxygen saturation of 89%. What is the nurse's first priority
intervention?
,A. Administer prescribed opioid analgesic
B. Apply supplemental oxygen via nasal cannula at 2 L/min
C. Encourage the patient to take deep breaths and use the incentive spirometer
D. Position the patient in high-Fowler's and stimulate to take deep breaths [CORRECT]
Correct Answer: D
Rationale: Correct because the patient is demonstrating hypoventilation with
hypoxemia; stimulating deep breathing and repositioning addresses airway clearance
and ventilation as the immediate priority before oxygen administration per ABC
protocol.
Q3: A postoperative patient on the second day after abdominal surgery reports sudden
severe pain at the incision site and the nurse notes serosanguineous drainage on the
dressing. Upon inspection, the nurse observes bowel protruding through the incision.
What is the priority nursing action?
A. Apply a sterile gauze dressing soaked in normal saline and notify the surgeon
[CORRECT]
B. Push the protruding bowel back into the abdominal cavity
C. Cover the wound with a dry sterile dressing and place the patient supine
D. Administer IV opioid analgesic and prepare for emergency surgery
Correct Answer: A
Rationale: Correct because this indicates wound dehiscence with evisceration; the
nurse must cover the exposed bowel with a sterile saline-moistened dressing to prevent
tissue desiccation and infection while immediately notifying the surgeon for emergency
repair.
Q4: A patient with a serum potassium level of 2.8 mEq/L is receiving IV potassium
chloride. Which nursing action is essential during administration?
,A. Administer via gravity drip without a pump to prevent infiltration
B. Administer via peripheral IV at a rate not exceeding 10 mEq/hour [CORRECT]
C. Mix potassium in dextrose 5% solution to enhance cellular uptake
D. Administer IV push for rapid correction of hypokalemia
Correct Answer: B
Rationale: Correct because IV potassium must never be given as a bolus due to risk of
cardiac arrest; peripheral administration should not exceed 10 mEq/hour, and
continuous cardiac monitoring is required during infusion.
Q5: A patient with metabolic acidosis has the following arterial blood gas results: pH
7.28, PaCO2 38 mmHg, HCO3 16 mEq/L. What is the primary compensatory mechanism
the nurse should anticipate?
A. Hyperventilation to decrease PaCO2
B. Hypoventilation to increase PaCO2
C. Renal retention of bicarbonate
D. Renal excretion of hydrogen ions [CORRECT]
Correct Answer: D
Rationale: Correct because in metabolic acidosis, the kidneys compensate by increasing
hydrogen ion excretion and generating new bicarbonate; respiratory compensation
through hyperventilation occurs but is not the primary renal compensatory mechanism
described.
Q6: A patient in the PACU after general anesthesia is shivering uncontrollably. The nurse
notes a core temperature of 35.2°C (95.4°F). What is the most appropriate nursing
intervention?
A. Apply ice packs to reduce metabolic demand
, B. Apply warm blankets and use a forced-air warming device [CORRECT]
C. Administer prescribed antipyretic medication
D. Increase IV fluid rate to improve circulation
Correct Answer: B
Rationale: Correct because postoperative shivering indicates hypothermia from
anesthesia-induced vasodilation and impaired thermoregulation; active rewarming with
forced-air warming devices and warm blankets is the priority intervention.
Q7: A patient with heart failure is receiving furosemide 40 mg IV twice daily. The nurse
should monitor for which electrolyte imbalance most commonly associated with this
therapy?
A. Hyperkalemia
B. Hypokalemia [CORRECT]
C. Hypernatremia
D. Hypercalcemia
Correct Answer: B
Rationale: Correct because furosemide is a loop diuretic that inhibits sodium and
chloride reabsorption in the ascending loop of Henle, causing increased potassium
excretion in urine and placing the patient at high risk for hypokalemia.
Q8: During preoperative assessment, a patient reports a history of malignant
hyperthermia in a sibling. What is the nurse's priority action?
A. Document the family history and proceed with standard preoperative preparation
B. Ensure dantrolene is available and communicate risk to the anesthesia team
[CORRECT]
C. Cancel the surgery until genetic testing can be completed
D. Administer prophylactic dantrolene preoperatively
