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NU 155 Medical-Surgical Nursing I Final Exam
Actual Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Section 1: Perioperative Nursing & Patient Safety
Q1: A patient is scheduled for a 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 [CORRECT]
D. 0700
Correct Answer: C
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.
Q2: 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
[CORRECT]
C. Obtaining the informed consent on behalf of the surgeon
D. Ensuring the patient agrees with the surgeon's recommendation
Correct Answer: B
Rationale: The nurse acts as a witness to the signing of the consent form, verifying that the
patient is voluntarily signing and appears to understand what was explained by the provider. The
nurse does not obtain consent or explain the medical risks.
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Q3: 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 [CORRECT]
B. Neuroleptic malignant syndrome
C. Anaphylactic shock
D. Septic shock
Correct Answer: A
Rationale: Malignant hyperthermia (MH) is a genetic condition triggered by volatile anesthetics
and succinylcholine. Early signs include masseter muscle rigidity, tachycardia, and hypercapnia
(increased end-tidal CO2) due to rapid metabolic activity in muscles.
Q4: What is the first-line medication of choice for treating malignant hyperthermia?
A. Dantrolene sodium [CORRECT]
B. Epinephrine
C. Atropine
D. Diphenhydramine
Correct Answer: A
Rationale: Dantrolene directly acts on skeletal muscle to inhibit calcium release from the
sarcoplasmic reticulum, halting the hypermetabolic state of malignant hyperthermia. It must be
administered immediately along with cooling measures and 100% oxygen.
Q5: 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 [CORRECT]
D. Intake and output
Correct Answer: C
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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.
Q6: 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."
[CORRECT]
B. "Cough forcefully every 4 hours to clear secretions."
C. "Lie flat on your back to expand your lung fields."
D. "Use a pillow to splint your abdomen only when you feel pain."
Correct Answer: A
Rationale: Incentive spirometry maximizes lung inflation and prevents alveolar collapse
(atelectasis). The standard goal is 10 breaths per hour while awake. Splinting should be done
during coughing and deep breathing, not just when pain occurs.
Q7: A postoperative patient has a temperature of 100.8°F (38.2°C), crackles in the lower lobes,
and complains of difficulty taking deep breaths. Which postoperative complication is most likely
occurring?
A. Pulmonary embolism
B. Atelectasis progressing to pneumonia [CORRECT]
C. Deep vein thrombosis
D. Hypovolemic shock
Correct Answer: B
Rationale: Atelectasis is the most common postoperative respiratory complication, often caused
by shallow breathing due to pain. If untreated, stasis of secretions can lead to a secondary
infection (pneumonia), evidenced by fever and crackles.
Q8: A patient on postoperative day 3 develops unilateral leg swelling, calf pain, and warmth.
What is the nurse's priority action?
A. Massage the affected calf to relieve the pain.
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B. Apply a warm compress to the area.
C. Elevate the leg above the level of the heart.
D. Maintain bed rest and notify the provider immediately. [CORRECT]
Correct Answer: D
Rationale: These are classic signs of a deep vein thrombosis (DVT). Massaging the calf can
dislodge the clot, leading to a fatal pulmonary embolism. The priority is to keep the patient on
bed rest to prevent embolization and notify the provider for an ultrasound and anticoagulation.
Q9: A patient suddenly develops acute dyspnea, chest pain, tachycardia, and hypotension on
postoperative day 5. Which condition should the nurse suspect?
A. Myocardial infarction
B. Pulmonary embolism [CORRECT]
C. Pneumothorax
D. Aspiration pneumonia
Correct Answer: B
Rationale: Sudden onset of dyspnea, chest pain, and hemodynamic instability (tachycardia,
hypotension) in a postoperative patient strongly suggest a pulmonary embolism, a life-
threatening complication of a DVT.
Q10: A patient who had abdominal surgery has absent bowel sounds, abdominal distension, and
nausea. Which postoperative complication is indicated?
A. Paralytic ileus [CORRECT]
B. Small bowel obstruction
C. Wound dehiscence
D. Peritonitis
Correct Answer: A
Rationale: A paralytic ileus is a temporary cessation of intestinal peristalsis, common after
abdominal surgery due to handling of the bowels or anesthesia. It presents with absent bowel
sounds, distension, and nausea.
NU 155 Medical-Surgical Nursing I Final Exam
Actual Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Section 1: Perioperative Nursing & Patient Safety
Q1: A patient is scheduled for a 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 [CORRECT]
D. 0700
Correct Answer: C
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.
Q2: 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
[CORRECT]
C. Obtaining the informed consent on behalf of the surgeon
D. Ensuring the patient agrees with the surgeon's recommendation
Correct Answer: B
Rationale: The nurse acts as a witness to the signing of the consent form, verifying that the
patient is voluntarily signing and appears to understand what was explained by the provider. The
nurse does not obtain consent or explain the medical risks.
,2
Q3: 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 [CORRECT]
B. Neuroleptic malignant syndrome
C. Anaphylactic shock
D. Septic shock
Correct Answer: A
Rationale: Malignant hyperthermia (MH) is a genetic condition triggered by volatile anesthetics
and succinylcholine. Early signs include masseter muscle rigidity, tachycardia, and hypercapnia
(increased end-tidal CO2) due to rapid metabolic activity in muscles.
Q4: What is the first-line medication of choice for treating malignant hyperthermia?
A. Dantrolene sodium [CORRECT]
B. Epinephrine
C. Atropine
D. Diphenhydramine
Correct Answer: A
Rationale: Dantrolene directly acts on skeletal muscle to inhibit calcium release from the
sarcoplasmic reticulum, halting the hypermetabolic state of malignant hyperthermia. It must be
administered immediately along with cooling measures and 100% oxygen.
Q5: 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 [CORRECT]
D. Intake and output
Correct Answer: C
,3
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.
Q6: 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."
[CORRECT]
B. "Cough forcefully every 4 hours to clear secretions."
C. "Lie flat on your back to expand your lung fields."
D. "Use a pillow to splint your abdomen only when you feel pain."
Correct Answer: A
Rationale: Incentive spirometry maximizes lung inflation and prevents alveolar collapse
(atelectasis). The standard goal is 10 breaths per hour while awake. Splinting should be done
during coughing and deep breathing, not just when pain occurs.
Q7: A postoperative patient has a temperature of 100.8°F (38.2°C), crackles in the lower lobes,
and complains of difficulty taking deep breaths. Which postoperative complication is most likely
occurring?
A. Pulmonary embolism
B. Atelectasis progressing to pneumonia [CORRECT]
C. Deep vein thrombosis
D. Hypovolemic shock
Correct Answer: B
Rationale: Atelectasis is the most common postoperative respiratory complication, often caused
by shallow breathing due to pain. If untreated, stasis of secretions can lead to a secondary
infection (pneumonia), evidenced by fever and crackles.
Q8: A patient on postoperative day 3 develops unilateral leg swelling, calf pain, and warmth.
What is the nurse's priority action?
A. Massage the affected calf to relieve the pain.
, 4
B. Apply a warm compress to the area.
C. Elevate the leg above the level of the heart.
D. Maintain bed rest and notify the provider immediately. [CORRECT]
Correct Answer: D
Rationale: These are classic signs of a deep vein thrombosis (DVT). Massaging the calf can
dislodge the clot, leading to a fatal pulmonary embolism. The priority is to keep the patient on
bed rest to prevent embolization and notify the provider for an ultrasound and anticoagulation.
Q9: A patient suddenly develops acute dyspnea, chest pain, tachycardia, and hypotension on
postoperative day 5. Which condition should the nurse suspect?
A. Myocardial infarction
B. Pulmonary embolism [CORRECT]
C. Pneumothorax
D. Aspiration pneumonia
Correct Answer: B
Rationale: Sudden onset of dyspnea, chest pain, and hemodynamic instability (tachycardia,
hypotension) in a postoperative patient strongly suggest a pulmonary embolism, a life-
threatening complication of a DVT.
Q10: A patient who had abdominal surgery has absent bowel sounds, abdominal distension, and
nausea. Which postoperative complication is indicated?
A. Paralytic ileus [CORRECT]
B. Small bowel obstruction
C. Wound dehiscence
D. Peritonitis
Correct Answer: A
Rationale: A paralytic ileus is a temporary cessation of intestinal peristalsis, common after
abdominal surgery due to handling of the bowels or anesthesia. It presents with absent bowel
sounds, distension, and nausea.
