NU 155
EXAM 3
Tested Questions with Rationales
Medical-Surgical Nursing I
Galen College of Nursing
This Document Description:
This document contains a collection of tested and
verified questions with accurate answers from
Exam 3 of NU 155 at the Galen College of Nursing.
It covers core topics assessed in the course and
reflects the actual exam format and question style. Ideal for exam
preparation and concept reinforcement.
,The nurse is monitoring a client's surgical incision and notes an
increase in the amount of drainage, a separation of the incision line,
and the appearance of underlying tissue. Which of the following is an
appropriate action for the nurse to take?
A) Cover the wound loosely with a sterile dry dressing.
B) Apply a sterile, normal-saline soaked dressing to the wound.
C) Massage the wound edges gently to promote healing.
D) Clean the wound with hydrogen peroxide and apply antibiotic ointment.
**Correct Answer:** B) Apply a sterile, normal-saline soaked dressing to
the wound.
**Expert Rationale:**
This presentation is consistent with wound dehiscence, a complication
where the surgical wound separates. It is crucial to cover the area with a
sterile saline-soaked dressing to keep the tissues moist and prevent
contamination while minimizing trauma. Dry dressings can cause tissue
desiccation, and hydrogen peroxide can damage new granulation tissue.
Massaging the wound edges is contraindicated.
---
### 2.
The nurse is providing preoperative instructions to a client who is
scheduled for surgery to correct spinal curvature. Which of the
following statements by the client best demonstrates a correct
understanding of the teaching?
,A) "I will limit my movements completely after surgery."
B) "I will show you the method of turning I will use after surgery."
C) "I can get out of bed as soon as I feel like it."
D) "Pain medication will not be necessary after surgery."
**Correct Answer:** B) "I will show you the method of turning I will use
after surgery."
**Expert Rationale:**
Preoperative teaching often involves instructing clients on postoperative
mobility techniques to prevent injury and promote healing. Demonstrating
turning techniques shows patient engagement and understanding. Early
mobilization prevents complications, and pain management is necessary
for recovery.
---
### 3.
The nurse is assessing a postoperative client who has advanced
cognitive impairment. Which of the following actions by the nurse is
most effective when assessing the client's level of pain?
A) Ask the client to rate pain on a scale from 0 to 10.
B) Monitor the client's body language, facial expressions, emotional status,
and consolability.
C) Assume no pain if there is no verbal complaint.
, D) Measure vital signs only.
**Correct Answer:** B) Monitor the client's body language, facial
expressions, emotional status, and consolability.
**Expert Rationale:**
Clients with advanced cognitive impairment may have limited ability to self-
report pain. Observational pain assessment tools that include behavior and
emotional cues are considered the most reliable strategies to identify pain
in this population.
---
### 4.
The nurse is caring for a client who has diabetes mellitus and reports
sharp, burning pain in bilateral lower extremities. The nurse
understands that the client may be experiencing:
A) Nociceptive pain.
B) Referred pain.
C) Neuropathic pain.
D) Phantom limb pain.
**Correct Answer:** C) Neuropathic pain.
**Expert Rationale:**
EXAM 3
Tested Questions with Rationales
Medical-Surgical Nursing I
Galen College of Nursing
This Document Description:
This document contains a collection of tested and
verified questions with accurate answers from
Exam 3 of NU 155 at the Galen College of Nursing.
It covers core topics assessed in the course and
reflects the actual exam format and question style. Ideal for exam
preparation and concept reinforcement.
,The nurse is monitoring a client's surgical incision and notes an
increase in the amount of drainage, a separation of the incision line,
and the appearance of underlying tissue. Which of the following is an
appropriate action for the nurse to take?
A) Cover the wound loosely with a sterile dry dressing.
B) Apply a sterile, normal-saline soaked dressing to the wound.
C) Massage the wound edges gently to promote healing.
D) Clean the wound with hydrogen peroxide and apply antibiotic ointment.
**Correct Answer:** B) Apply a sterile, normal-saline soaked dressing to
the wound.
**Expert Rationale:**
This presentation is consistent with wound dehiscence, a complication
where the surgical wound separates. It is crucial to cover the area with a
sterile saline-soaked dressing to keep the tissues moist and prevent
contamination while minimizing trauma. Dry dressings can cause tissue
desiccation, and hydrogen peroxide can damage new granulation tissue.
Massaging the wound edges is contraindicated.
---
### 2.
The nurse is providing preoperative instructions to a client who is
scheduled for surgery to correct spinal curvature. Which of the
following statements by the client best demonstrates a correct
understanding of the teaching?
,A) "I will limit my movements completely after surgery."
B) "I will show you the method of turning I will use after surgery."
C) "I can get out of bed as soon as I feel like it."
D) "Pain medication will not be necessary after surgery."
**Correct Answer:** B) "I will show you the method of turning I will use
after surgery."
**Expert Rationale:**
Preoperative teaching often involves instructing clients on postoperative
mobility techniques to prevent injury and promote healing. Demonstrating
turning techniques shows patient engagement and understanding. Early
mobilization prevents complications, and pain management is necessary
for recovery.
---
### 3.
The nurse is assessing a postoperative client who has advanced
cognitive impairment. Which of the following actions by the nurse is
most effective when assessing the client's level of pain?
A) Ask the client to rate pain on a scale from 0 to 10.
B) Monitor the client's body language, facial expressions, emotional status,
and consolability.
C) Assume no pain if there is no verbal complaint.
, D) Measure vital signs only.
**Correct Answer:** B) Monitor the client's body language, facial
expressions, emotional status, and consolability.
**Expert Rationale:**
Clients with advanced cognitive impairment may have limited ability to self-
report pain. Observational pain assessment tools that include behavior and
emotional cues are considered the most reliable strategies to identify pain
in this population.
---
### 4.
The nurse is caring for a client who has diabetes mellitus and reports
sharp, burning pain in bilateral lower extremities. The nurse
understands that the client may be experiencing:
A) Nociceptive pain.
B) Referred pain.
C) Neuropathic pain.
D) Phantom limb pain.
**Correct Answer:** C) Neuropathic pain.
**Expert Rationale:**
