MED SURG 201 - Final Exam West Coast University | NCLEX-RN Aligned | 2026/2027 Edition
MED SURG 201 Final Exam
Questions and Answers (West Coast University)
Comprehensive Final Examination | 150 Multiple-Choice Questions | Aligned with NCLEX-RN Test Plan and
Medical-Surgical Nursing Core Competencies (2026/2027 Edition)
Section 1: Perioperative Nursing
Q1: A 67-year-old male is scheduled for an elective cholecystectomy in the morning. While reviewing the chart,
the nurse notes the patient takes warfarin 5 mg daily for atrial fibrillation. Which action should the nurse take
FIRST?
A. Teach the patient about deep breathing and splinting incisions postoperatively.
B. Notify the surgeon and anesthesia provider about the warfarin use immediately. *[CORRECT]*
C. Document the finding and continue with the preoperative checklist.
D. Administer vitamin K intramuscularly as a routine preoperative medication.
Correct Answer: B
Rationale: Warfarin is an anticoagulant that significantly increases surgical bleeding risk; the surgeon and anesthesia provider
must be notified immediately so the procedure can be delayed or bridging therapy (e.g., heparin) initiated. West Coast
University perioperative protocol and NCLEX-RN safety standards require the nurse to escalate medication-related bleeding
risks before proceeding with any preoperative teaching. Vitamin K should never be administered without a provider order, and
simply documenting the finding fails to address a life-threatening risk.
Q2: A patient is admitted to the PACU after general anesthesia. The patient has loud upper airway sounds,
oxygen saturation is 88%, and chest retractions are visible. Which intervention should the PACU nurse
implement FIRST?
A. Insert an oral airway and suction the oropharynx.
B. Increase the oxygen flow rate to 10 L/min via simple face mask.
C. Perform jaw thrust and chin lift maneuver. *[CORRECT]*
D. Call the anesthesia provider for immediate reintubation.
Correct Answer: C
Rationale: The jaw thrust and chin lift maneuver is the FIRST priority because the clinical picture indicates upper airway
obstruction from a relaxed tongue or secretions, common post-anesthesia. Opening the airway often resolves the obstruction
immediately and improves oxygenation. Per the ABC framework emphasized in NCLEX-RN and the WCU perioperative
curriculum, airway always comes before breathing interventions such as increasing oxygen or calling for reintubation.
Suctioning or oral airway insertion follows once the airway is patent.
MED SURG 201 - Final Examination 150 Questions | Cognitive Levels: Recall / Application / Analysis Page 1
,MED SURG 201 - Final Exam West Coast University | NCLEX-RN Aligned | 2026/2027 Edition
Q3: A postoperative patient who had an open abdominal surgery 24 hours ago reports a "popping" sensation
when coughing. The nurse observes a loop of bowel protruding through the incision. Which action should the
nurse take FIRST?
A. Cover the wound with sterile saline-soaked gauze and notify the surgeon. *[CORRECT]*
B. Instruct the patient to lie flat and remain NPO.
C. Gently push the bowel back into the abdominal cavity using sterile technique.
D. Apply an abdominal binder tightly and reassess in 30 minutes.
Correct Answer: A
Rationale: This is wound evisceration, a surgical emergency requiring immediate sterile saline-soaked gauze coverage to
prevent drying and infection, followed by notification of the surgeon for emergency surgical repair. The patient should be
positioned in low Fowler's with knees bent to reduce abdominal pressure, but covering the organs is the first action. Reinserting
the bowel risks perforation and contamination, and applying a binder could further compromise the protruding tissue.
Q4: The nurse is preparing a 54-year-old female for a mastectomy. The patient signed the consent form 2 hours
ago but now states, "I am not sure I want to do this. Maybe I should try radiation first." What is the most
appropriate nursing action?
A. Reassure the patient that the surgery is the best option and proceed with preparation.
B. Notify the surgeon immediately so the patient can discuss concerns before the procedure. *[CORRECT]*
C. Remind the patient that she already signed the consent and is legally bound.
D. Administer the prescribed preoperative lorazepam to reduce anxiety.
Correct Answer: B
Rationale: Informed consent requires the patient to fully understand and agree to the procedure without coercion; any
uncertainty must be communicated to the surgeon so the patient can re-evaluate. Perioperative nursing standards and the WCU
legal/ethical curriculum emphasize that the nurse acts as patient advocate when consent is questioned. Administering sedatives
before the patient has resolved concerns would impair the patient's ability to make an informed decision.
Q5: Which of the following preoperative assessment findings requires the MOST immediate follow-up by the
nurse?
A. A potassium level of 3.4 mEq/L in a patient scheduled for a hernia repair.
B. A hemoglobin of 11.2 g/dL in a patient scheduled for total knee replacement.
C. A serum sodium of 150 mEq/L in a patient scheduled for hip pinning.
D. A platelet count of 80,000/mm3 in a patient scheduled for coronary artery bypass graft. *[CORRECT]*
Correct Answer: D
Rationale: A platelet count of 80,000/mm3 (normal 150,000-400,000) places the CABG patient at extreme risk for
intraoperative hemorrhage because cardiopulmonary bypass further impairs platelet function and heparinization is required.
The nurse must notify the surgeon and anesthesia provider immediately for possible platelet transfusion. While the other values
are abnormal, they do not carry the same immediate intraoperative mortality risk in the scheduled procedures.
MED SURG 201 - Final Examination 150 Questions | Cognitive Levels: Recall / Application / Analysis Page 2
,MED SURG 201 - Final Exam West Coast University | NCLEX-RN Aligned | 2026/2027 Edition
Q6: A patient in the PACU has a core body temperature of 34.5 C (94.1 F), is shivering vigorously, and has an
oxygen saturation of 92%. Which nursing intervention is the PRIORITY?
A. Administer meperidine 25 mg IV as prescribed for post-anesthesia shivering.
B. Apply forced warm air blanket and increase oxygen to 100%. *[CORRECT]*
C. Position the patient lateral and suction the airway.
D. Assess the surgical site for bleeding.
Correct Answer: B
Rationale: Hypothermia with shivering dramatically increases oxygen consumption (up to 400%) and myocardial workload,
worsening the existing hypoxemia. The priority is active rewarming with a forced warm air blanket and supplemental oxygen to
break the shivering cycle. Meperidine may be used for refractory shivering but only after rewarming is initiated; airway
suctioning and bleeding assessment, while important, do not address the immediate cardiopulmonary threat.
Q7: A nurse is caring for four postoperative patients on a medical-surgical unit. Which patient should the nurse
assess FIRST?
A. A patient 8 hours post-colectomy with absent bowel sounds and a soft abdomen.
B. A patient 12 hours post-thyroidectomy who reports a tingling sensation in the lips and fingers. *[CORRECT]*
C. A patient 24 hours post-cholecystectomy complaining of incisional pain rated 6/10.
D. A patient 4 hours post-appendectomy who has not yet voided.
Correct Answer: B
Rationale: Lip and finger tingling after thyroidectomy suggests hypocalcemia from accidental parathyroid removal or damage,
which can rapidly progress to life-threatening laryngospasm and cardiac dysrhythmias. This patient must be assessed first.
Absent bowel sounds 8 hours postoperatively are expected, incisional pain is routine, and failure to void within 4 hours is not
yet abnormal; these findings require monitoring but not the same urgency.
Q8: A patient who received general anesthesia 30 minutes ago in the PACU has absent gag reflex, respiratory
rate of 8, and pinpoint pupils. Which medication should the nurse anticipate administering?
A. Naloxone hydrochloride (Narcan) *[CORRECT]*
B. Flumazenil (Romazicon)
C. Neostigmine (Prostigmin)
D. Physostigmine (Antilirium)
Correct Answer: A
Rationale: The combination of respiratory depression (RR 8), pinpoint pupils, and depressed consciousness strongly suggests
opioid-induced respiratory depression, particularly from intraoperative fentanyl or morphine. Naloxone, an opioid antagonist,
is the antidote. Flumazenil reverses benzodiazepines (not indicated by pinpoint pupils), and neostigmine is used to reverse
neuromuscular blockade, which would present differently with muscle weakness rather than pinpoint pupils.
MED SURG 201 - Final Examination 150 Questions | Cognitive Levels: Recall / Application / Analysis Page 3
, MED SURG 201 - Final Exam West Coast University | NCLEX-RN Aligned | 2026/2027 Edition
Q9: A postoperative patient is being discharged with a prescription for oxycodone/acetaminophen (Percocet).
Which statement by the patient indicates a need for FURTHER teaching?
A. "I will take a stool softener daily while I am on this medication."
B. "I can take two tablets every 4 hours around the clock for the first 24 hours." *[CORRECT]*
C. "I should not drink any alcoholic beverages while taking this medication."
D. "I will avoid taking over-the-counter cold medicines that contain acetaminophen."
Correct Answer: B
Rationale: Percocet contains acetaminophen (325 mg per tablet), and the FDA maximum daily acetaminophen dose is 3,000 mg
for adults (4,000 mg historically). Taking two tablets every 4 hours around the clock would equal 3,900 mg of acetaminophen
daily, risking hepatotoxicity. The patient should be taught to follow the prescribed dosing interval and not exceed the maximum.
The other statements reflect appropriate teaching regarding constipation, alcohol avoidance, and avoiding duplicate
acetaminophen products.
Q10: A patient is 6 hours postoperative following a total hip arthroplasty. Which finding requires the nurse to
intervene immediately?
A. A small amount of serosanguineous drainage on the surgical dressing.
B. A swollen, firm, and painful calf on the operative leg. *[CORRECT]*
C. A temperature of 99.2 F (37.3 C) at the incision site.
D. A urinary output of 240 mL in the last 6 hours.
Correct Answer: B
Rationale: A swollen, firm, painful calf is the classic presentation of deep vein thrombosis (DVT), a life-threatening
complication that can progress to pulmonary embolism. The nurse must immediately notify the provider, elevate the leg, and
anticipate anticoagulant therapy or imaging. Serosanguineous drainage, mild low-grade fever, and 40 mL/hr urine output are
all expected postoperative findings requiring continued monitoring but not immediate intervention.
Q11: A nurse is teaching a patient about postoperative incentive spirometry. Which statement by the patient
demonstrates correct understanding?
A. "I will use the spirometer once a day before meals."
B. "I will exhale slowly into the mouthpiece to elevate the balls."
C. "I will inhale slowly and deeply through the mouthpiece to sustain the indicator." *[CORRECT]*
D. "I will use the spirometer only when I feel short of breath."
Correct Answer: C
Rationale: Incentive spirometry requires the patient to inhale slowly and deeply through the mouthpiece to sustain the indicator
flow marker, which promotes alveolar expansion and prevents atelectasis. The device should be used 10 times every hour while
awake, not once daily or only when symptomatic. Exhaling into the device defeats its purpose, as the goal is sustained maximal
inspiration.
MED SURG 201 - Final Examination 150 Questions | Cognitive Levels: Recall / Application / Analysis Page 4
MED SURG 201 Final Exam
Questions and Answers (West Coast University)
Comprehensive Final Examination | 150 Multiple-Choice Questions | Aligned with NCLEX-RN Test Plan and
Medical-Surgical Nursing Core Competencies (2026/2027 Edition)
Section 1: Perioperative Nursing
Q1: A 67-year-old male is scheduled for an elective cholecystectomy in the morning. While reviewing the chart,
the nurse notes the patient takes warfarin 5 mg daily for atrial fibrillation. Which action should the nurse take
FIRST?
A. Teach the patient about deep breathing and splinting incisions postoperatively.
B. Notify the surgeon and anesthesia provider about the warfarin use immediately. *[CORRECT]*
C. Document the finding and continue with the preoperative checklist.
D. Administer vitamin K intramuscularly as a routine preoperative medication.
Correct Answer: B
Rationale: Warfarin is an anticoagulant that significantly increases surgical bleeding risk; the surgeon and anesthesia provider
must be notified immediately so the procedure can be delayed or bridging therapy (e.g., heparin) initiated. West Coast
University perioperative protocol and NCLEX-RN safety standards require the nurse to escalate medication-related bleeding
risks before proceeding with any preoperative teaching. Vitamin K should never be administered without a provider order, and
simply documenting the finding fails to address a life-threatening risk.
Q2: A patient is admitted to the PACU after general anesthesia. The patient has loud upper airway sounds,
oxygen saturation is 88%, and chest retractions are visible. Which intervention should the PACU nurse
implement FIRST?
A. Insert an oral airway and suction the oropharynx.
B. Increase the oxygen flow rate to 10 L/min via simple face mask.
C. Perform jaw thrust and chin lift maneuver. *[CORRECT]*
D. Call the anesthesia provider for immediate reintubation.
Correct Answer: C
Rationale: The jaw thrust and chin lift maneuver is the FIRST priority because the clinical picture indicates upper airway
obstruction from a relaxed tongue or secretions, common post-anesthesia. Opening the airway often resolves the obstruction
immediately and improves oxygenation. Per the ABC framework emphasized in NCLEX-RN and the WCU perioperative
curriculum, airway always comes before breathing interventions such as increasing oxygen or calling for reintubation.
Suctioning or oral airway insertion follows once the airway is patent.
MED SURG 201 - Final Examination 150 Questions | Cognitive Levels: Recall / Application / Analysis Page 1
,MED SURG 201 - Final Exam West Coast University | NCLEX-RN Aligned | 2026/2027 Edition
Q3: A postoperative patient who had an open abdominal surgery 24 hours ago reports a "popping" sensation
when coughing. The nurse observes a loop of bowel protruding through the incision. Which action should the
nurse take FIRST?
A. Cover the wound with sterile saline-soaked gauze and notify the surgeon. *[CORRECT]*
B. Instruct the patient to lie flat and remain NPO.
C. Gently push the bowel back into the abdominal cavity using sterile technique.
D. Apply an abdominal binder tightly and reassess in 30 minutes.
Correct Answer: A
Rationale: This is wound evisceration, a surgical emergency requiring immediate sterile saline-soaked gauze coverage to
prevent drying and infection, followed by notification of the surgeon for emergency surgical repair. The patient should be
positioned in low Fowler's with knees bent to reduce abdominal pressure, but covering the organs is the first action. Reinserting
the bowel risks perforation and contamination, and applying a binder could further compromise the protruding tissue.
Q4: The nurse is preparing a 54-year-old female for a mastectomy. The patient signed the consent form 2 hours
ago but now states, "I am not sure I want to do this. Maybe I should try radiation first." What is the most
appropriate nursing action?
A. Reassure the patient that the surgery is the best option and proceed with preparation.
B. Notify the surgeon immediately so the patient can discuss concerns before the procedure. *[CORRECT]*
C. Remind the patient that she already signed the consent and is legally bound.
D. Administer the prescribed preoperative lorazepam to reduce anxiety.
Correct Answer: B
Rationale: Informed consent requires the patient to fully understand and agree to the procedure without coercion; any
uncertainty must be communicated to the surgeon so the patient can re-evaluate. Perioperative nursing standards and the WCU
legal/ethical curriculum emphasize that the nurse acts as patient advocate when consent is questioned. Administering sedatives
before the patient has resolved concerns would impair the patient's ability to make an informed decision.
Q5: Which of the following preoperative assessment findings requires the MOST immediate follow-up by the
nurse?
A. A potassium level of 3.4 mEq/L in a patient scheduled for a hernia repair.
B. A hemoglobin of 11.2 g/dL in a patient scheduled for total knee replacement.
C. A serum sodium of 150 mEq/L in a patient scheduled for hip pinning.
D. A platelet count of 80,000/mm3 in a patient scheduled for coronary artery bypass graft. *[CORRECT]*
Correct Answer: D
Rationale: A platelet count of 80,000/mm3 (normal 150,000-400,000) places the CABG patient at extreme risk for
intraoperative hemorrhage because cardiopulmonary bypass further impairs platelet function and heparinization is required.
The nurse must notify the surgeon and anesthesia provider immediately for possible platelet transfusion. While the other values
are abnormal, they do not carry the same immediate intraoperative mortality risk in the scheduled procedures.
MED SURG 201 - Final Examination 150 Questions | Cognitive Levels: Recall / Application / Analysis Page 2
,MED SURG 201 - Final Exam West Coast University | NCLEX-RN Aligned | 2026/2027 Edition
Q6: A patient in the PACU has a core body temperature of 34.5 C (94.1 F), is shivering vigorously, and has an
oxygen saturation of 92%. Which nursing intervention is the PRIORITY?
A. Administer meperidine 25 mg IV as prescribed for post-anesthesia shivering.
B. Apply forced warm air blanket and increase oxygen to 100%. *[CORRECT]*
C. Position the patient lateral and suction the airway.
D. Assess the surgical site for bleeding.
Correct Answer: B
Rationale: Hypothermia with shivering dramatically increases oxygen consumption (up to 400%) and myocardial workload,
worsening the existing hypoxemia. The priority is active rewarming with a forced warm air blanket and supplemental oxygen to
break the shivering cycle. Meperidine may be used for refractory shivering but only after rewarming is initiated; airway
suctioning and bleeding assessment, while important, do not address the immediate cardiopulmonary threat.
Q7: A nurse is caring for four postoperative patients on a medical-surgical unit. Which patient should the nurse
assess FIRST?
A. A patient 8 hours post-colectomy with absent bowel sounds and a soft abdomen.
B. A patient 12 hours post-thyroidectomy who reports a tingling sensation in the lips and fingers. *[CORRECT]*
C. A patient 24 hours post-cholecystectomy complaining of incisional pain rated 6/10.
D. A patient 4 hours post-appendectomy who has not yet voided.
Correct Answer: B
Rationale: Lip and finger tingling after thyroidectomy suggests hypocalcemia from accidental parathyroid removal or damage,
which can rapidly progress to life-threatening laryngospasm and cardiac dysrhythmias. This patient must be assessed first.
Absent bowel sounds 8 hours postoperatively are expected, incisional pain is routine, and failure to void within 4 hours is not
yet abnormal; these findings require monitoring but not the same urgency.
Q8: A patient who received general anesthesia 30 minutes ago in the PACU has absent gag reflex, respiratory
rate of 8, and pinpoint pupils. Which medication should the nurse anticipate administering?
A. Naloxone hydrochloride (Narcan) *[CORRECT]*
B. Flumazenil (Romazicon)
C. Neostigmine (Prostigmin)
D. Physostigmine (Antilirium)
Correct Answer: A
Rationale: The combination of respiratory depression (RR 8), pinpoint pupils, and depressed consciousness strongly suggests
opioid-induced respiratory depression, particularly from intraoperative fentanyl or morphine. Naloxone, an opioid antagonist,
is the antidote. Flumazenil reverses benzodiazepines (not indicated by pinpoint pupils), and neostigmine is used to reverse
neuromuscular blockade, which would present differently with muscle weakness rather than pinpoint pupils.
MED SURG 201 - Final Examination 150 Questions | Cognitive Levels: Recall / Application / Analysis Page 3
, MED SURG 201 - Final Exam West Coast University | NCLEX-RN Aligned | 2026/2027 Edition
Q9: A postoperative patient is being discharged with a prescription for oxycodone/acetaminophen (Percocet).
Which statement by the patient indicates a need for FURTHER teaching?
A. "I will take a stool softener daily while I am on this medication."
B. "I can take two tablets every 4 hours around the clock for the first 24 hours." *[CORRECT]*
C. "I should not drink any alcoholic beverages while taking this medication."
D. "I will avoid taking over-the-counter cold medicines that contain acetaminophen."
Correct Answer: B
Rationale: Percocet contains acetaminophen (325 mg per tablet), and the FDA maximum daily acetaminophen dose is 3,000 mg
for adults (4,000 mg historically). Taking two tablets every 4 hours around the clock would equal 3,900 mg of acetaminophen
daily, risking hepatotoxicity. The patient should be taught to follow the prescribed dosing interval and not exceed the maximum.
The other statements reflect appropriate teaching regarding constipation, alcohol avoidance, and avoiding duplicate
acetaminophen products.
Q10: A patient is 6 hours postoperative following a total hip arthroplasty. Which finding requires the nurse to
intervene immediately?
A. A small amount of serosanguineous drainage on the surgical dressing.
B. A swollen, firm, and painful calf on the operative leg. *[CORRECT]*
C. A temperature of 99.2 F (37.3 C) at the incision site.
D. A urinary output of 240 mL in the last 6 hours.
Correct Answer: B
Rationale: A swollen, firm, painful calf is the classic presentation of deep vein thrombosis (DVT), a life-threatening
complication that can progress to pulmonary embolism. The nurse must immediately notify the provider, elevate the leg, and
anticipate anticoagulant therapy or imaging. Serosanguineous drainage, mild low-grade fever, and 40 mL/hr urine output are
all expected postoperative findings requiring continued monitoring but not immediate intervention.
Q11: A nurse is teaching a patient about postoperative incentive spirometry. Which statement by the patient
demonstrates correct understanding?
A. "I will use the spirometer once a day before meals."
B. "I will exhale slowly into the mouthpiece to elevate the balls."
C. "I will inhale slowly and deeply through the mouthpiece to sustain the indicator." *[CORRECT]*
D. "I will use the spirometer only when I feel short of breath."
Correct Answer: C
Rationale: Incentive spirometry requires the patient to inhale slowly and deeply through the mouthpiece to sustain the indicator
flow marker, which promotes alveolar expansion and prevents atelectasis. The device should be used 10 times every hour while
awake, not once daily or only when symptomatic. Exhaling into the device defeats its purpose, as the goal is sustained maximal
inspiration.
MED SURG 201 - Final Examination 150 Questions | Cognitive Levels: Recall / Application / Analysis Page 4
