NUR 242 Medical-Surgical Nursing Concepts
Exams 1-4 Questions and Answers| Galen College of Nursing
,Exam 1
1. A client is scheduled for surgery and signs the informed consent form. Which action
is most appropriate for the nurse?
A. Explain the risks and benefits of the surgery in detail
B. Witness the client's signature and verify understanding
C. Decide whether the client is competent to consent
D. Obtain the consent form on behalf of the surgeon
Answer: B. Witness the client's signature and verify understanding
Rationale: Explaining risks/benefits and obtaining consent are the surgeon's
responsibility. The nurse's role is to witness the signature, confirm the client signed
voluntarily, and verify the client understands the information given by the surgeon,
notifying the surgeon if understanding is lacking.
2. The nurse is completing a preoperative checklist. Which finding requires immediate
notification of the surgeon?
A. Client ate a light breakfast 9 hours ago
B. Client's potassium level is 2.9 mEq/L
C. Client is anxious about the procedure
D. Client removed nail polish as instructed
Answer: B. Client's potassium level is 2.9 mEq/L
Rationale: A potassium of 2.9 mEq/L is below normal (3.5-5.0 mEq/L) and increases
the risk of dysrhythmias under anesthesia; this critical value must be reported before
surgery proceeds.
3. Which statement by a client scheduled for surgery indicates a need for further
teaching about NPO status?
A. I can have clear liquids up to 2 hours before surgery
B. I should stop eating solid food at midnight
C. I can chew gum this morning since it is not food
D. I will tell the anesthesiologist about my last meal
Answer: C. I can chew gum this morning since it is not food
Rationale: Chewing gum stimulates gastric secretions and increases aspiration risk; it
is not permitted during the NPO period, even though it is not a solid food.
,4. A client returns from surgery under general anesthesia and is difficult to arouse
with a heart rate of 130, temperature of 104F, and rigid muscles. The nurse suspects
which complication?
A. Malignant hyperthermia
B. Anaphylaxis
C. Septic shock
D. Delayed emergence
Answer: A. Malignant hyperthermia
Rationale: Malignant hyperthermia is a life-threatening hypermetabolic reaction to
anesthetic agents presenting with rapid rise in temperature, tachycardia, and muscle
rigidity; it requires immediate discontinuation of the trigger agent and dantrolene
administration.
5. Which nursing intervention best prevents postoperative atelectasis?
A. Encouraging incentive spirometry every 1-2 hours while awake
B. Keeping the client NPO for 24 hours
C. Restricting fluids to prevent pulmonary edema
D. Maintaining strict bed rest for 48 hours
Answer: A. Encouraging incentive spirometry every 1-2 hours while awake
Rationale: Incentive spirometry promotes deep breathing and lung expansion,
preventing alveolar collapse (atelectasis) common after surgery, especially with
abdominal or thoracic incisions.
6. A postoperative client reports sudden sharp chest pain and dyspnea on
postoperative day 2. The nurse should first suspect which complication?
A. Pulmonary embolism
B. Wound dehiscence
C. Paralytic ileus
D. Urinary retention
Answer: A. Pulmonary embolism
Rationale: Sudden pleuritic chest pain with dyspnea in a postoperative client is a
classic presentation of pulmonary embolism, often from a dislodged deep vein
thrombosis; this is a medical emergency requiring immediate assessment and oxygen.
7. To prevent deep vein thrombosis after surgery, which order should the nurse
anticipate?
, A. Early ambulation and sequential compression devices
B. Strict bed rest for one week
C. Warm compresses to both legs
D. Restriction of oral fluids
Answer: A. Early ambulation and sequential compression devices
Rationale: Early ambulation and mechanical prophylaxis such as sequential
compression devices promote venous return and reduce venous stasis, the primary
risk factor for DVT formation.
8. A client's abdominal incision suddenly opens with viscera protruding. What is the
nurse's priority action?
A. Cover the area with sterile saline-soaked gauze and notify the surgeon
B. Attempt to push the organs back into the abdomen
C. Apply a dry sterile dressing and document the finding
D. Ask the client to cough to assess pain level
Answer: A. Cover the area with sterile saline-soaked gauze and notify the surgeon
Rationale: Evisceration is an emergency; the nurse covers exposed organs with sterile
saline-soaked gauze to keep tissue moist, keeps the client NPO and calm, and notifies
the surgeon immediately for emergency repair. Organs are never pushed back in.
9. The nurse is teaching a client about general versus spinal anesthesia before surgery.
Which statement about spinal anesthesia is correct?
A. It causes complete loss of consciousness
B. It carries a risk of post-procedure headache from CSF leak
C. It is delivered through inhaled gas
D. It requires endotracheal intubation
Answer: B. It carries a risk of post-procedure headache from CSF leak
Rationale: Spinal anesthesia involves injection of an anesthetic into the subarachnoid
space; a common complication is a post-dural puncture headache caused by
cerebrospinal fluid leakage, relieved by lying flat and hydration.
10. Which client statement indicates understanding of discharge teaching after
outpatient surgery under moderate sedation?
A. I will drive myself home since I feel alert
B. I can resume normal activity immediately
C. I will have someone stay with me for 24 hours
Exams 1-4 Questions and Answers| Galen College of Nursing
,Exam 1
1. A client is scheduled for surgery and signs the informed consent form. Which action
is most appropriate for the nurse?
A. Explain the risks and benefits of the surgery in detail
B. Witness the client's signature and verify understanding
C. Decide whether the client is competent to consent
D. Obtain the consent form on behalf of the surgeon
Answer: B. Witness the client's signature and verify understanding
Rationale: Explaining risks/benefits and obtaining consent are the surgeon's
responsibility. The nurse's role is to witness the signature, confirm the client signed
voluntarily, and verify the client understands the information given by the surgeon,
notifying the surgeon if understanding is lacking.
2. The nurse is completing a preoperative checklist. Which finding requires immediate
notification of the surgeon?
A. Client ate a light breakfast 9 hours ago
B. Client's potassium level is 2.9 mEq/L
C. Client is anxious about the procedure
D. Client removed nail polish as instructed
Answer: B. Client's potassium level is 2.9 mEq/L
Rationale: A potassium of 2.9 mEq/L is below normal (3.5-5.0 mEq/L) and increases
the risk of dysrhythmias under anesthesia; this critical value must be reported before
surgery proceeds.
3. Which statement by a client scheduled for surgery indicates a need for further
teaching about NPO status?
A. I can have clear liquids up to 2 hours before surgery
B. I should stop eating solid food at midnight
C. I can chew gum this morning since it is not food
D. I will tell the anesthesiologist about my last meal
Answer: C. I can chew gum this morning since it is not food
Rationale: Chewing gum stimulates gastric secretions and increases aspiration risk; it
is not permitted during the NPO period, even though it is not a solid food.
,4. A client returns from surgery under general anesthesia and is difficult to arouse
with a heart rate of 130, temperature of 104F, and rigid muscles. The nurse suspects
which complication?
A. Malignant hyperthermia
B. Anaphylaxis
C. Septic shock
D. Delayed emergence
Answer: A. Malignant hyperthermia
Rationale: Malignant hyperthermia is a life-threatening hypermetabolic reaction to
anesthetic agents presenting with rapid rise in temperature, tachycardia, and muscle
rigidity; it requires immediate discontinuation of the trigger agent and dantrolene
administration.
5. Which nursing intervention best prevents postoperative atelectasis?
A. Encouraging incentive spirometry every 1-2 hours while awake
B. Keeping the client NPO for 24 hours
C. Restricting fluids to prevent pulmonary edema
D. Maintaining strict bed rest for 48 hours
Answer: A. Encouraging incentive spirometry every 1-2 hours while awake
Rationale: Incentive spirometry promotes deep breathing and lung expansion,
preventing alveolar collapse (atelectasis) common after surgery, especially with
abdominal or thoracic incisions.
6. A postoperative client reports sudden sharp chest pain and dyspnea on
postoperative day 2. The nurse should first suspect which complication?
A. Pulmonary embolism
B. Wound dehiscence
C. Paralytic ileus
D. Urinary retention
Answer: A. Pulmonary embolism
Rationale: Sudden pleuritic chest pain with dyspnea in a postoperative client is a
classic presentation of pulmonary embolism, often from a dislodged deep vein
thrombosis; this is a medical emergency requiring immediate assessment and oxygen.
7. To prevent deep vein thrombosis after surgery, which order should the nurse
anticipate?
, A. Early ambulation and sequential compression devices
B. Strict bed rest for one week
C. Warm compresses to both legs
D. Restriction of oral fluids
Answer: A. Early ambulation and sequential compression devices
Rationale: Early ambulation and mechanical prophylaxis such as sequential
compression devices promote venous return and reduce venous stasis, the primary
risk factor for DVT formation.
8. A client's abdominal incision suddenly opens with viscera protruding. What is the
nurse's priority action?
A. Cover the area with sterile saline-soaked gauze and notify the surgeon
B. Attempt to push the organs back into the abdomen
C. Apply a dry sterile dressing and document the finding
D. Ask the client to cough to assess pain level
Answer: A. Cover the area with sterile saline-soaked gauze and notify the surgeon
Rationale: Evisceration is an emergency; the nurse covers exposed organs with sterile
saline-soaked gauze to keep tissue moist, keeps the client NPO and calm, and notifies
the surgeon immediately for emergency repair. Organs are never pushed back in.
9. The nurse is teaching a client about general versus spinal anesthesia before surgery.
Which statement about spinal anesthesia is correct?
A. It causes complete loss of consciousness
B. It carries a risk of post-procedure headache from CSF leak
C. It is delivered through inhaled gas
D. It requires endotracheal intubation
Answer: B. It carries a risk of post-procedure headache from CSF leak
Rationale: Spinal anesthesia involves injection of an anesthetic into the subarachnoid
space; a common complication is a post-dural puncture headache caused by
cerebrospinal fluid leakage, relieved by lying flat and hydration.
10. Which client statement indicates understanding of discharge teaching after
outpatient surgery under moderate sedation?
A. I will drive myself home since I feel alert
B. I can resume normal activity immediately
C. I will have someone stay with me for 24 hours
