,NUR 242 Medical Surgical Nursing
Concepts Exam Prep — Comprehensive
Review + Practice MCQs — Galen
College of Nursing 2025/2026
1. A patient scheduled for surgery reports a family history of sudden death during anesthesia and prior
episodes of high fever with surgery. The nurse should notify the surgical team of an increased risk for which
condition?
A. Anaphylactic shock
B. Malignant hyperthermia
C. Hypovolemic shock
D. Septicemia
Correct Answer: B
Rationale: Malignant hyperthermia is a rare, life-threatening genetic disorder triggered by certain anesthetic
agents (especially volatile inhalants and succinylcholine). It is characterized by a rapid rise in body
temperature, muscle rigidity, hypermetabolism, and rhabdomyolysis. A family history of sudden death during
anesthesia or prior hyperthermic reactions strongly suggests this risk.
2. A patient is being prepared for surgery. Which laboratory value requires notification of the surgeon before
proceeding?
A. Sodium 138 mEq/L
B. Potassium 3.1 mEq/L
C. Hemoglobin 13.5 g/dL
D. Glucose 110 mg/dL
Correct Answer: B
,Rationale: Hypokalemia (serum potassium < 3.5 mEq/L) increases the risk of cardiac dysrhythmias during
surgery and anesthesia. It should be corrected before elective surgery. The other values are within normal
limits.
3. A postoperative patient has a temperature of 102.4°F (39.1°C) on postoperative day 2, along with wound
redness and purulent drainage. The nurse should suspect which complication?
A. Atelectasis
B. Wound infection
C. Malignant hyperthermia
D. Pulmonary embolism
Correct Answer: B
Rationale: Fever on postoperative day 2 or later, combined with local signs of inflammation (redness, warmth,
purulent drainage), is most consistent with a surgical site infection. Atelectasis typically causes low-grade fever
in the first 24–48 hours. Malignant hyperthermia occurs intraoperatively. Pulmonary embolism presents with
tachycardia, dyspnea, and pleuritic chest pain, not purulent wound drainage.
4. A patient is 6 hours postoperative from abdominal surgery. The nurse notes the dressing is saturated with
bright red blood, and the patient’s blood pressure has dropped from 118/72 to 92/58 mm Hg. What is the
nurse’s priority action?
A. Reinforce the dressing and document the finding
B. Apply pressure to the wound and notify the surgeon immediately
C. Elevate the head of the bed and administer pain medication
D. Obtain a complete blood count and wait for results
Correct Answer: B
, Rationale: Bright red bleeding with signs of hemodynamic instability (decreasing blood pressure) suggests
postoperative hemorrhage. The priority is to apply direct pressure to control bleeding and immediately notify
the surgeon. Reinforcing the dressing without assessment delays intervention. Documentation is important but
not the priority. Waiting for labs delays necessary intervention.
5. A patient is scheduled for surgery and asks the nurse why they must stop eating and drinking after midnight.
What is the nurse’s best response?
A. “It prevents you from feeling nauseated after surgery.”
B. “It reduces the risk of aspiration during anesthesia.”
C. “It makes the surgery go faster.”
D. “It prevents you from developing an infection.”
Correct Answer: B
Rationale: Preoperative fasting reduces gastric volume and acidity, decreasing the risk of aspiration of gastric
contents during induction of anesthesia. Aspiration can cause aspiration pneumonitis, which is a serious
complication. The other options are not the primary rationale for NPO status.
6. The nurse is completing a preoperative assessment. Which finding should be reported to the surgeon and
anesthesia provider immediately?
A. The patient takes a daily multivitamin.
B. The patient reports a loose tooth.
C. The patient’s hemoglobin A1c is 6.2%.
D. The patient had a cold 2 weeks ago that resolved.
Correct Answer: B
Rationale: A loose tooth is a significant risk during intubation because it can be dislodged and aspirated,
leading to airway obstruction. This finding must be communicated to the anesthesia provider so precautions
can be taken. The other findings are either normal or not immediate safety concerns.
Concepts Exam Prep — Comprehensive
Review + Practice MCQs — Galen
College of Nursing 2025/2026
1. A patient scheduled for surgery reports a family history of sudden death during anesthesia and prior
episodes of high fever with surgery. The nurse should notify the surgical team of an increased risk for which
condition?
A. Anaphylactic shock
B. Malignant hyperthermia
C. Hypovolemic shock
D. Septicemia
Correct Answer: B
Rationale: Malignant hyperthermia is a rare, life-threatening genetic disorder triggered by certain anesthetic
agents (especially volatile inhalants and succinylcholine). It is characterized by a rapid rise in body
temperature, muscle rigidity, hypermetabolism, and rhabdomyolysis. A family history of sudden death during
anesthesia or prior hyperthermic reactions strongly suggests this risk.
2. A patient is being prepared for surgery. Which laboratory value requires notification of the surgeon before
proceeding?
A. Sodium 138 mEq/L
B. Potassium 3.1 mEq/L
C. Hemoglobin 13.5 g/dL
D. Glucose 110 mg/dL
Correct Answer: B
,Rationale: Hypokalemia (serum potassium < 3.5 mEq/L) increases the risk of cardiac dysrhythmias during
surgery and anesthesia. It should be corrected before elective surgery. The other values are within normal
limits.
3. A postoperative patient has a temperature of 102.4°F (39.1°C) on postoperative day 2, along with wound
redness and purulent drainage. The nurse should suspect which complication?
A. Atelectasis
B. Wound infection
C. Malignant hyperthermia
D. Pulmonary embolism
Correct Answer: B
Rationale: Fever on postoperative day 2 or later, combined with local signs of inflammation (redness, warmth,
purulent drainage), is most consistent with a surgical site infection. Atelectasis typically causes low-grade fever
in the first 24–48 hours. Malignant hyperthermia occurs intraoperatively. Pulmonary embolism presents with
tachycardia, dyspnea, and pleuritic chest pain, not purulent wound drainage.
4. A patient is 6 hours postoperative from abdominal surgery. The nurse notes the dressing is saturated with
bright red blood, and the patient’s blood pressure has dropped from 118/72 to 92/58 mm Hg. What is the
nurse’s priority action?
A. Reinforce the dressing and document the finding
B. Apply pressure to the wound and notify the surgeon immediately
C. Elevate the head of the bed and administer pain medication
D. Obtain a complete blood count and wait for results
Correct Answer: B
, Rationale: Bright red bleeding with signs of hemodynamic instability (decreasing blood pressure) suggests
postoperative hemorrhage. The priority is to apply direct pressure to control bleeding and immediately notify
the surgeon. Reinforcing the dressing without assessment delays intervention. Documentation is important but
not the priority. Waiting for labs delays necessary intervention.
5. A patient is scheduled for surgery and asks the nurse why they must stop eating and drinking after midnight.
What is the nurse’s best response?
A. “It prevents you from feeling nauseated after surgery.”
B. “It reduces the risk of aspiration during anesthesia.”
C. “It makes the surgery go faster.”
D. “It prevents you from developing an infection.”
Correct Answer: B
Rationale: Preoperative fasting reduces gastric volume and acidity, decreasing the risk of aspiration of gastric
contents during induction of anesthesia. Aspiration can cause aspiration pneumonitis, which is a serious
complication. The other options are not the primary rationale for NPO status.
6. The nurse is completing a preoperative assessment. Which finding should be reported to the surgeon and
anesthesia provider immediately?
A. The patient takes a daily multivitamin.
B. The patient reports a loose tooth.
C. The patient’s hemoglobin A1c is 6.2%.
D. The patient had a cold 2 weeks ago that resolved.
Correct Answer: B
Rationale: A loose tooth is a significant risk during intubation because it can be dislodged and aspirated,
leading to airway obstruction. This finding must be communicated to the anesthesia provider so precautions
can be taken. The other findings are either normal or not immediate safety concerns.
