GALEN COLLEGE OF NURSING
NUR 265 Medical-Surgical Nursing
Exam 1 Comprehensive Preparation Examination
Academic Year 2026-2027 | Aligned with Current Clinical Practice Guidelines and Course Standards
Total
Content Sections Question Format Cognitive Level Mix
Questions
30% Recall | 50%
7 body-system sections Multiple choice, 4 options
100 Application | 20%
(Q1-Q100) (A-D), one correct answer
Analysis
Examination Instructions. This preparation examination contains 100 multiple-choice items mapped to the NUR
265 Exam 1 blueprint. Each item presents a clinical scenario or focused knowledge statement followed by four
options; select the ONE best answer. The correct answer and a rationale explaining the pathophysiologic mechanism
and clinical reasoning follow every item. Questions emphasize prioritization (ABCs, safety, Maslow), assessment
interpretation, medication calculation, commonly confused concept pairs, and patient education. Recommended
time: 120 minutes without rationales; allow additional sessions for rationale review.
SECTION 1 | PERIOPERATIVE NURSING CARE
Preoperative Assessment | Intraoperative Care | Postoperative Complications | Anesthesia (Questions 1-15)
Q1: A nurse is preparing a 58-year-old client for a laparoscopic cholecystectomy. When reviewing the
informed consent form, the client states, 'The surgeon just told me I need my gallbladder out, but I am not
really sure what happens during the surgery.' Which action should the nurse take first?
A. Explain the surgical procedure in detail so the client can make an informed decision and sign the
form
B. Notify the surgeon that the client needs further explanation of the procedure before consent is
obtained [CORRECT]
C. Ask the client to sign the form because the consent was already discussed during the preadmission
visit
D. Document that the client is undecided and send the signed form with the client to the operating
room
Correct Answer: B
Rationale: The surgeon is legally responsible for explaining the procedure, its risks, benefits, and alternatives; the nurse
may only clarify information after teaching, not provide the initial explanation. Signing consent requires the client to
demonstrate understanding, so the surgeon must return before the form is valid. Options A and C overstep the nurse's
legal role and could invalidate consent, and option D is unsafe because an unconsented, uninformed client should never
proceed to the operating room.
Galen College of Nursing | NUR 265 Exam 1 1
,NUR 265 Medical-Surgical Nursing - Exam 1 Comprehensive Preparation (2026-2027) Sections 1-7 | 100 Questions
Q2: A nurse is reviewing the preoperative laboratory results of a client scheduled for an open abdominal
hysterectomy in the morning. Which finding requires immediate notification of the surgeon?
A. Hemoglobin of 13.2 g/dL
B. White blood cell count of 7,500/mm3
C. Serum potassium of 3.1 mEq/L [CORRECT]
D. Blood urea nitrogen of 16 mg/dL
Correct Answer: C
Rationale: Hypokalemia (normal 3.5-5.0 mEq/L) potentiates cardiac dysrhythmias, especially under general anesthesia
and with muscle relaxants, so it must be corrected before surgery. The hemoglobin, WBC, and BUN values are all within
normal limits and do not delay surgery. Recognizing abnormal versus normal preoperative labs is a core NUR 265 safety
competency because electrolyte imbalances are a correctable cause of intraoperative cardiac events.
Q3: A preoperative client asks the nurse why it is so important to practice coughing, deep breathing, and
incentive spirometry before surgery. Which explanation by the nurse is most accurate?
A. These exercises raise the pain threshold so fewer opioid analgesics will be needed after surgery
B. These exercises expand the alveoli and mobilize secretions, which prevents postoperative atelectasis
and pneumonia [CORRECT]
C. These exercises increase circulating blood volume and prevent hypotension during the
intraoperative period
D. These exercises strengthen the abdominal muscles so the surgical incision will heal without
dehiscence
Correct Answer: B
Rationale: General anesthesia, opioids, and pain with breathing cause shallow respirations, suppressed cough, and
alveolar collapse; practicing ventilation techniques beforehand increases the likelihood the client will perform them
effectively postoperatively, when atelectasis risk peaks within the first 24 to 48 hours. The exercises have no meaningful
effect on pain threshold, intravascular volume, or abdominal muscle strength. Prevention of pulmonary complications is
the single most important rationale for preoperative respiratory teaching.
Q4: A client is scheduled for surgery at 0800. At 0630 during the final preoperative check, the nurse learns
the client ate a bowl of cereal and drank a cup of coffee at 0545. Which action should the nurse take first?
A. Allow the surgery to proceed but document the intake accurately on the preoperative checklist
B. Encourage the client to ambulate to promote gastric emptying before the trip to the operating room
C. Notify the surgeon and anesthesia provider because the scheduled surgery will likely be delayed or
postponed [CORRECT]
D. Administer the prescribed preoperative sedation so the client can rest until the operating room is
ready
Correct Answer: C
Rationale: Recent oral intake within the required NPO period creates a serious aspiration risk during induction of
general anesthesia because protective airway reflexes are abolished; the anesthesia provider and surgeon must be
notified so the case can be delayed. Documentation alone (option A) does not protect the client, ambulation and sedation
do not empty the stomach safely, and sedating a client with a full stomach compounds the aspiration hazard. Advocacy
through notification is the priority nursing action.
Galen College of Nursing | NUR 265 Exam 1 2
,NUR 265 Medical-Surgical Nursing - Exam 1 Comprehensive Preparation (2026-2027) Sections 1-7 | 100 Questions
Q5: A nurse is reconciling a client's home medications before surgery. Which medication should the nurse
anticipate holding before the procedure based on current perioperative safety guidelines?
A. Levothyroxine taken each morning for hypothyroidism
B. Pantoprazole taken daily for gastroesophageal reflux
C. Fluticasone inhaler used daily for asthma control
D. Metformin taken twice daily for type 2 diabetes [CORRECT]
Correct Answer: D
Rationale: Metformin is typically withheld the day of surgery and for about 48 hours afterward because reduced renal
perfusion and contrast exposure perioperatively increase the risk of lactic acidosis. Levothyroxine, inhaled
corticosteroids, and proton pump inhibitors are generally continued through the perioperative period, and inhaled
steroids are actually important for respiratory stability. Medication reconciliation with attention to antidiabetics,
anticoagulants, and herbal products is a standard preoperative nursing responsibility.
Q6: During a surgical time-out immediately before skin incision, which activity demonstrates correct
participation by the circulating nurse?
A. Verifying the client's identity, the planned procedure, and the correct surgical site with the entire
team [CORRECT]
B. Documenting the counts of sponges and instruments while the surgeon prepares to make the
incision
C. Confirming that the consent form is signed and then leaving the verification to the anesthesia
provider
D. Checking the client's blood type and crossmatch results that were completed the previous day
Correct Answer: A
Rationale: The Universal Protocol time-out requires every member of the surgical team to actively stop and verify the
correct client, correct procedure, and correct site before incision; passive assumptions and delegating verification to one
person defeat the safety check. Sponge and instrument counts (option B) are separate safety tasks performed at defined
times, and reviewing a blood type from the prior day is not part of the time-out. Wrong-site and wrong-procedure
surgery are never-events, making active participation in the time-out a legal and professional obligation.
Q7: Which action by a member of the surgical team demonstrates correct maintenance of surgical asepsis?
A. Holding sterile gloved hands above the waist and within the line of vision at all times [CORRECT]
B. Turning away from the sterile field to speak with the anesthesia provider across the room
C. Placing a sterile instrument on the edge of the sterile drape that hangs below the table level
D. Reaching across the sterile field to quickly reposition the overhead surgical light
Correct Answer: A
Rationale: Items held below the waist, behind the back, or outside the line of vision are considered contaminated
because they cannot be watched, so keeping hands above the waist and in sight preserves sterility. Turning the back to
the field (option B) contaminates the front of the gown, the drape below table level is not sterile, and reaching over the
field drops lint and organisms onto sterile surfaces. Aseptic technique violations are the primary mechanism of surgical
site infections.
Galen College of Nursing | NUR 265 Exam 1 3
, NUR 265 Medical-Surgical Nursing - Exam 1 Comprehensive Preparation (2026-2027) Sections 1-7 | 100 Questions
Q8: A client under general anesthesia with a volatile agent develops tachycardia, generalized muscle
rigidity, a rapidly rising temperature of 39.8 degrees C (103.6 degrees F), and end-tidal CO2 that climbs
despite increased ventilation. The nurse in the operating room should recognize these findings as indicative
of which complication?
A. Anaphylactic reaction to the antibiotic administered during induction
B. Hypovolemic shock from unrecognized intraoperative blood loss
C. Neuroleptic malignant syndrome from a preoperative antipsychotic dose
D. Malignant hyperthermia triggered by the volatile anesthetic agent [CORRECT]
Correct Answer: D
Rationale: The combination of hypercarbia with rising end-tidal CO2, tachycardia, muscle rigidity, and a rapid
temperature increase under a volatile anesthetic or succinylcholine is the classic presentation of malignant hyperthermia,
a hypermetabolic crisis of skeletal muscle calcium dysregulation. Anaphylaxis produces bronchospasm, rash, and
hypotension rather than rigidity and hypercarbia, hemorrhagic shock produces hypotension and falling CO2, and
neuroleptic malignant syndrome develops hours to days after antipsychotic exposure rather than intraoperatively. Early
recognition directly determines survival.
Q9: Malignant hyperthermia has just been confirmed in an operating room client. Which intervention
should the nurse expect to implement first?
A. Administer dantrolene sodium as prescribed and discontinue the triggering anesthetic agents
[CORRECT]
B. Apply a cooling blanket and place the client in a tub of ice water before any medications are given
C. Increase the volatile anesthetic to deepen anesthesia and suppress the hypermetabolic response
D. Administer protamine sulfate to reverse the anesthetic agents causing the reaction
Correct Answer: A
Rationale: Definitive treatment is immediate dantrolene (initial dose 2.5 mg/kg IV, repeated until rigidity and
hypercarbia resolve) together with stopping the volatile agents or succinylcholine, hyperventilating with 100 percent
oxygen, and active cooling. Cooling measures support but never replace dantrolene (option B), deepening anesthesia
with the trigger agent would worsen the crisis, and protamine reverses heparin, not anesthetics. Nursing preparedness
includes verifying dantrolene availability whenever malignant hyperthermia susceptibility is identified.
Q10: Thirty minutes after induction of spinal anesthesia for a knee arthroscopy, a client reports nausea and
the blood pressure falls from 126/78 to 84/52 mm Hg. Which intervention should the nurse anticipate first?
A. Rapid infusion of prescribed IV fluid and administration of a vasopressor to restore vascular tone
[CORRECT]
B. Head-of-bed elevation to 60 degrees to redirect blood flow to the core circulation
C. Immediate administration of an antiemetic and continued observation for further hypotension
D. Removal of the epidural catheter to stop the progression of the sympathetic blockade
Correct Answer: A
Rationale: Spinal anesthesia blocks sympathetic vasomotor tone below the level of the block, causing vasodilation,
venous pooling, and reflex bradycardia; the standard response is aggressive IV fluid loading plus vasopressors such as
phenylephrine or ephedrine to restore preload and perfusion. Elevating the head worsens hypotension, treating nausea
without addressing perfusion risks cerebral and coronary hypoperfusion, and removing a catheter is not the treatment for
systemic hypotension. Untreated spinal hypotension can progress to cardiac arrest, making this a high-yield PACU
assessment.
Galen College of Nursing | NUR 265 Exam 1 4
NUR 265 Medical-Surgical Nursing
Exam 1 Comprehensive Preparation Examination
Academic Year 2026-2027 | Aligned with Current Clinical Practice Guidelines and Course Standards
Total
Content Sections Question Format Cognitive Level Mix
Questions
30% Recall | 50%
7 body-system sections Multiple choice, 4 options
100 Application | 20%
(Q1-Q100) (A-D), one correct answer
Analysis
Examination Instructions. This preparation examination contains 100 multiple-choice items mapped to the NUR
265 Exam 1 blueprint. Each item presents a clinical scenario or focused knowledge statement followed by four
options; select the ONE best answer. The correct answer and a rationale explaining the pathophysiologic mechanism
and clinical reasoning follow every item. Questions emphasize prioritization (ABCs, safety, Maslow), assessment
interpretation, medication calculation, commonly confused concept pairs, and patient education. Recommended
time: 120 minutes without rationales; allow additional sessions for rationale review.
SECTION 1 | PERIOPERATIVE NURSING CARE
Preoperative Assessment | Intraoperative Care | Postoperative Complications | Anesthesia (Questions 1-15)
Q1: A nurse is preparing a 58-year-old client for a laparoscopic cholecystectomy. When reviewing the
informed consent form, the client states, 'The surgeon just told me I need my gallbladder out, but I am not
really sure what happens during the surgery.' Which action should the nurse take first?
A. Explain the surgical procedure in detail so the client can make an informed decision and sign the
form
B. Notify the surgeon that the client needs further explanation of the procedure before consent is
obtained [CORRECT]
C. Ask the client to sign the form because the consent was already discussed during the preadmission
visit
D. Document that the client is undecided and send the signed form with the client to the operating
room
Correct Answer: B
Rationale: The surgeon is legally responsible for explaining the procedure, its risks, benefits, and alternatives; the nurse
may only clarify information after teaching, not provide the initial explanation. Signing consent requires the client to
demonstrate understanding, so the surgeon must return before the form is valid. Options A and C overstep the nurse's
legal role and could invalidate consent, and option D is unsafe because an unconsented, uninformed client should never
proceed to the operating room.
Galen College of Nursing | NUR 265 Exam 1 1
,NUR 265 Medical-Surgical Nursing - Exam 1 Comprehensive Preparation (2026-2027) Sections 1-7 | 100 Questions
Q2: A nurse is reviewing the preoperative laboratory results of a client scheduled for an open abdominal
hysterectomy in the morning. Which finding requires immediate notification of the surgeon?
A. Hemoglobin of 13.2 g/dL
B. White blood cell count of 7,500/mm3
C. Serum potassium of 3.1 mEq/L [CORRECT]
D. Blood urea nitrogen of 16 mg/dL
Correct Answer: C
Rationale: Hypokalemia (normal 3.5-5.0 mEq/L) potentiates cardiac dysrhythmias, especially under general anesthesia
and with muscle relaxants, so it must be corrected before surgery. The hemoglobin, WBC, and BUN values are all within
normal limits and do not delay surgery. Recognizing abnormal versus normal preoperative labs is a core NUR 265 safety
competency because electrolyte imbalances are a correctable cause of intraoperative cardiac events.
Q3: A preoperative client asks the nurse why it is so important to practice coughing, deep breathing, and
incentive spirometry before surgery. Which explanation by the nurse is most accurate?
A. These exercises raise the pain threshold so fewer opioid analgesics will be needed after surgery
B. These exercises expand the alveoli and mobilize secretions, which prevents postoperative atelectasis
and pneumonia [CORRECT]
C. These exercises increase circulating blood volume and prevent hypotension during the
intraoperative period
D. These exercises strengthen the abdominal muscles so the surgical incision will heal without
dehiscence
Correct Answer: B
Rationale: General anesthesia, opioids, and pain with breathing cause shallow respirations, suppressed cough, and
alveolar collapse; practicing ventilation techniques beforehand increases the likelihood the client will perform them
effectively postoperatively, when atelectasis risk peaks within the first 24 to 48 hours. The exercises have no meaningful
effect on pain threshold, intravascular volume, or abdominal muscle strength. Prevention of pulmonary complications is
the single most important rationale for preoperative respiratory teaching.
Q4: A client is scheduled for surgery at 0800. At 0630 during the final preoperative check, the nurse learns
the client ate a bowl of cereal and drank a cup of coffee at 0545. Which action should the nurse take first?
A. Allow the surgery to proceed but document the intake accurately on the preoperative checklist
B. Encourage the client to ambulate to promote gastric emptying before the trip to the operating room
C. Notify the surgeon and anesthesia provider because the scheduled surgery will likely be delayed or
postponed [CORRECT]
D. Administer the prescribed preoperative sedation so the client can rest until the operating room is
ready
Correct Answer: C
Rationale: Recent oral intake within the required NPO period creates a serious aspiration risk during induction of
general anesthesia because protective airway reflexes are abolished; the anesthesia provider and surgeon must be
notified so the case can be delayed. Documentation alone (option A) does not protect the client, ambulation and sedation
do not empty the stomach safely, and sedating a client with a full stomach compounds the aspiration hazard. Advocacy
through notification is the priority nursing action.
Galen College of Nursing | NUR 265 Exam 1 2
,NUR 265 Medical-Surgical Nursing - Exam 1 Comprehensive Preparation (2026-2027) Sections 1-7 | 100 Questions
Q5: A nurse is reconciling a client's home medications before surgery. Which medication should the nurse
anticipate holding before the procedure based on current perioperative safety guidelines?
A. Levothyroxine taken each morning for hypothyroidism
B. Pantoprazole taken daily for gastroesophageal reflux
C. Fluticasone inhaler used daily for asthma control
D. Metformin taken twice daily for type 2 diabetes [CORRECT]
Correct Answer: D
Rationale: Metformin is typically withheld the day of surgery and for about 48 hours afterward because reduced renal
perfusion and contrast exposure perioperatively increase the risk of lactic acidosis. Levothyroxine, inhaled
corticosteroids, and proton pump inhibitors are generally continued through the perioperative period, and inhaled
steroids are actually important for respiratory stability. Medication reconciliation with attention to antidiabetics,
anticoagulants, and herbal products is a standard preoperative nursing responsibility.
Q6: During a surgical time-out immediately before skin incision, which activity demonstrates correct
participation by the circulating nurse?
A. Verifying the client's identity, the planned procedure, and the correct surgical site with the entire
team [CORRECT]
B. Documenting the counts of sponges and instruments while the surgeon prepares to make the
incision
C. Confirming that the consent form is signed and then leaving the verification to the anesthesia
provider
D. Checking the client's blood type and crossmatch results that were completed the previous day
Correct Answer: A
Rationale: The Universal Protocol time-out requires every member of the surgical team to actively stop and verify the
correct client, correct procedure, and correct site before incision; passive assumptions and delegating verification to one
person defeat the safety check. Sponge and instrument counts (option B) are separate safety tasks performed at defined
times, and reviewing a blood type from the prior day is not part of the time-out. Wrong-site and wrong-procedure
surgery are never-events, making active participation in the time-out a legal and professional obligation.
Q7: Which action by a member of the surgical team demonstrates correct maintenance of surgical asepsis?
A. Holding sterile gloved hands above the waist and within the line of vision at all times [CORRECT]
B. Turning away from the sterile field to speak with the anesthesia provider across the room
C. Placing a sterile instrument on the edge of the sterile drape that hangs below the table level
D. Reaching across the sterile field to quickly reposition the overhead surgical light
Correct Answer: A
Rationale: Items held below the waist, behind the back, or outside the line of vision are considered contaminated
because they cannot be watched, so keeping hands above the waist and in sight preserves sterility. Turning the back to
the field (option B) contaminates the front of the gown, the drape below table level is not sterile, and reaching over the
field drops lint and organisms onto sterile surfaces. Aseptic technique violations are the primary mechanism of surgical
site infections.
Galen College of Nursing | NUR 265 Exam 1 3
, NUR 265 Medical-Surgical Nursing - Exam 1 Comprehensive Preparation (2026-2027) Sections 1-7 | 100 Questions
Q8: A client under general anesthesia with a volatile agent develops tachycardia, generalized muscle
rigidity, a rapidly rising temperature of 39.8 degrees C (103.6 degrees F), and end-tidal CO2 that climbs
despite increased ventilation. The nurse in the operating room should recognize these findings as indicative
of which complication?
A. Anaphylactic reaction to the antibiotic administered during induction
B. Hypovolemic shock from unrecognized intraoperative blood loss
C. Neuroleptic malignant syndrome from a preoperative antipsychotic dose
D. Malignant hyperthermia triggered by the volatile anesthetic agent [CORRECT]
Correct Answer: D
Rationale: The combination of hypercarbia with rising end-tidal CO2, tachycardia, muscle rigidity, and a rapid
temperature increase under a volatile anesthetic or succinylcholine is the classic presentation of malignant hyperthermia,
a hypermetabolic crisis of skeletal muscle calcium dysregulation. Anaphylaxis produces bronchospasm, rash, and
hypotension rather than rigidity and hypercarbia, hemorrhagic shock produces hypotension and falling CO2, and
neuroleptic malignant syndrome develops hours to days after antipsychotic exposure rather than intraoperatively. Early
recognition directly determines survival.
Q9: Malignant hyperthermia has just been confirmed in an operating room client. Which intervention
should the nurse expect to implement first?
A. Administer dantrolene sodium as prescribed and discontinue the triggering anesthetic agents
[CORRECT]
B. Apply a cooling blanket and place the client in a tub of ice water before any medications are given
C. Increase the volatile anesthetic to deepen anesthesia and suppress the hypermetabolic response
D. Administer protamine sulfate to reverse the anesthetic agents causing the reaction
Correct Answer: A
Rationale: Definitive treatment is immediate dantrolene (initial dose 2.5 mg/kg IV, repeated until rigidity and
hypercarbia resolve) together with stopping the volatile agents or succinylcholine, hyperventilating with 100 percent
oxygen, and active cooling. Cooling measures support but never replace dantrolene (option B), deepening anesthesia
with the trigger agent would worsen the crisis, and protamine reverses heparin, not anesthetics. Nursing preparedness
includes verifying dantrolene availability whenever malignant hyperthermia susceptibility is identified.
Q10: Thirty minutes after induction of spinal anesthesia for a knee arthroscopy, a client reports nausea and
the blood pressure falls from 126/78 to 84/52 mm Hg. Which intervention should the nurse anticipate first?
A. Rapid infusion of prescribed IV fluid and administration of a vasopressor to restore vascular tone
[CORRECT]
B. Head-of-bed elevation to 60 degrees to redirect blood flow to the core circulation
C. Immediate administration of an antiemetic and continued observation for further hypotension
D. Removal of the epidural catheter to stop the progression of the sympathetic blockade
Correct Answer: A
Rationale: Spinal anesthesia blocks sympathetic vasomotor tone below the level of the block, causing vasodilation,
venous pooling, and reflex bradycardia; the standard response is aggressive IV fluid loading plus vasopressors such as
phenylephrine or ephedrine to restore preload and perfusion. Elevating the head worsens hypotension, treating nausea
without addressing perfusion risks cerebral and coronary hypoperfusion, and removing a catheter is not the treatment for
systemic hypotension. Untreated spinal hypotension can progress to cardiac arrest, making this a high-yield PACU
assessment.
Galen College of Nursing | NUR 265 Exam 1 4
