NU 155 Exam 1 Medical-Surgical Nursing I (2026)
Comprehensive Questions And Answers With Verified
Solutions & Expert Rationales
QUESTION 1
A patient is scheduled for major abdominal surgery at 0800. According to standard NPO guidelines, what
is the latest time the patient can consume clear liquids before surgery?
A. 0200
B. 0400
C. 0600
D. 0700
Correct Answer: C. 0600
Expert Rationale: Standard preoperative fasting guidelines allow clear liquids up to 2 hours before
surgery. Solid foods and non-clear liquids are restricted for 6-8 hours preoperatively to reduce the risk of
aspiration. Clear liquids include water, clear broth, and apple juice. The 2-hour rule allows some oral
intake while ensuring the stomach is empty at the time of anesthesia induction .
QUESTION 2
The surgeon explains the surgical procedure, risks, and benefits to the patient, and the patient signs the
consent form. What is the nurse's legal role in informed consent?
A. Explaining the surgical risks in medical terminology
B. Witnessing the patient's signature and verifying the patient understands the procedure
C. Obtaining the informed consent on behalf of the surgeon
D. Ensuring the patient agrees with the surgeon's recommendation
Correct Answer: B. Witnessing the patient's signature and verifying the patient understands the procedure
,Expert Rationale: The nurse's role in informed consent is to witness the patient's signature, verify that the
patient appears to understand what was explained by the provider, and that the patient is voluntarily
signing the consent form. The nurse does NOT explain the surgical procedure or obtain consent—these
are the physician's responsibilities. The nurse ensures the patient is informed but does not provide medical
explanations .
QUESTION 3
A patient in the operating room receives succinylcholine and begins to exhibit jaw tightness (masseter
spasm) and a rapid rise in end-tidal CO₂. The nurse recognizes these as early signs of which life-
threatening condition?
A. Malignant hyperthermia
B. Neuroleptic malignant syndrome
C. Anaphylactic shock
D. Septic shock
Correct Answer: A. Malignant hyperthermia
Expert Rationale: Malignant hyperthermia (MH) is a life-threatening genetic condition triggered by
volatile anesthetics and succinylcholine. Early signs include masseter muscle rigidity (jaw tightness),
tachycardia, and hypercapnia (increased end-tidal CO₂) due to rapid metabolic activity in muscles. This
condition requires immediate recognition and treatment to prevent death. Neuroleptic malignant
syndrome is related to antipsychotic medications, not anesthetics .
QUESTION 4
What is the first-line medication of choice for treating malignant hyperthermia?
A. Dantrolene sodium
B. Epinephrine
C. Atropine
D. Diphenhydramine
, Correct Answer: A. Dantrolene sodium
Expert Rationale: Dantrolene sodium is the first-line treatment for malignant hyperthermia. It acts directly
on skeletal muscle to inhibit calcium release from the sarcoplasmic reticulum, halting the hypermetabolic
state. It must be administered immediately along with cooling measures and 100% oxygen. Epinephrine,
atropine, and diphenhydramine are not effective for this condition .
QUESTION 5
In the post-anesthesia care unit (PACU), what is the priority nursing assessment during the immediate
postoperative period?
A. Pain level
B. Surgical site dressing
C. Airway patency and respiratory status
D. Intake and output
Correct Answer: C. Airway patency and respiratory status
Expert Rationale: The primary postoperative priority follows the ABCs (Airway, Breathing, Circulation).
Anesthesia and opioids depress the respiratory drive, so ensuring a patent airway and adequate ventilation
is the nurse's first priority. Pain, dressing, and output assessments are important but secondary to
maintaining respiratory function .
QUESTION 6
The nurse is providing preoperative teaching to a patient. Which instruction is most effective for
preventing postoperative atelectasis?
A. "Take deep breaths and use the incentive spirometry 10 times every hour while awake."
B. "Cough forcefully every 4 hours to clear secretions."
C. "Lie flat on your back to expand your lung fields."
Comprehensive Questions And Answers With Verified
Solutions & Expert Rationales
QUESTION 1
A patient is scheduled for major abdominal surgery at 0800. According to standard NPO guidelines, what
is the latest time the patient can consume clear liquids before surgery?
A. 0200
B. 0400
C. 0600
D. 0700
Correct Answer: C. 0600
Expert Rationale: Standard preoperative fasting guidelines allow clear liquids up to 2 hours before
surgery. Solid foods and non-clear liquids are restricted for 6-8 hours preoperatively to reduce the risk of
aspiration. Clear liquids include water, clear broth, and apple juice. The 2-hour rule allows some oral
intake while ensuring the stomach is empty at the time of anesthesia induction .
QUESTION 2
The surgeon explains the surgical procedure, risks, and benefits to the patient, and the patient signs the
consent form. What is the nurse's legal role in informed consent?
A. Explaining the surgical risks in medical terminology
B. Witnessing the patient's signature and verifying the patient understands the procedure
C. Obtaining the informed consent on behalf of the surgeon
D. Ensuring the patient agrees with the surgeon's recommendation
Correct Answer: B. Witnessing the patient's signature and verifying the patient understands the procedure
,Expert Rationale: The nurse's role in informed consent is to witness the patient's signature, verify that the
patient appears to understand what was explained by the provider, and that the patient is voluntarily
signing the consent form. The nurse does NOT explain the surgical procedure or obtain consent—these
are the physician's responsibilities. The nurse ensures the patient is informed but does not provide medical
explanations .
QUESTION 3
A patient in the operating room receives succinylcholine and begins to exhibit jaw tightness (masseter
spasm) and a rapid rise in end-tidal CO₂. The nurse recognizes these as early signs of which life-
threatening condition?
A. Malignant hyperthermia
B. Neuroleptic malignant syndrome
C. Anaphylactic shock
D. Septic shock
Correct Answer: A. Malignant hyperthermia
Expert Rationale: Malignant hyperthermia (MH) is a life-threatening genetic condition triggered by
volatile anesthetics and succinylcholine. Early signs include masseter muscle rigidity (jaw tightness),
tachycardia, and hypercapnia (increased end-tidal CO₂) due to rapid metabolic activity in muscles. This
condition requires immediate recognition and treatment to prevent death. Neuroleptic malignant
syndrome is related to antipsychotic medications, not anesthetics .
QUESTION 4
What is the first-line medication of choice for treating malignant hyperthermia?
A. Dantrolene sodium
B. Epinephrine
C. Atropine
D. Diphenhydramine
, Correct Answer: A. Dantrolene sodium
Expert Rationale: Dantrolene sodium is the first-line treatment for malignant hyperthermia. It acts directly
on skeletal muscle to inhibit calcium release from the sarcoplasmic reticulum, halting the hypermetabolic
state. It must be administered immediately along with cooling measures and 100% oxygen. Epinephrine,
atropine, and diphenhydramine are not effective for this condition .
QUESTION 5
In the post-anesthesia care unit (PACU), what is the priority nursing assessment during the immediate
postoperative period?
A. Pain level
B. Surgical site dressing
C. Airway patency and respiratory status
D. Intake and output
Correct Answer: C. Airway patency and respiratory status
Expert Rationale: The primary postoperative priority follows the ABCs (Airway, Breathing, Circulation).
Anesthesia and opioids depress the respiratory drive, so ensuring a patent airway and adequate ventilation
is the nurse's first priority. Pain, dressing, and output assessments are important but secondary to
maintaining respiratory function .
QUESTION 6
The nurse is providing preoperative teaching to a patient. Which instruction is most effective for
preventing postoperative atelectasis?
A. "Take deep breaths and use the incentive spirometry 10 times every hour while awake."
B. "Cough forcefully every 4 hours to clear secretions."
C. "Lie flat on your back to expand your lung fields."
