BSN 266 HESI MEDICAL-SURGICAL NURSING EXAM 1
Q&A – NURSING-FOCUSED, HIGH TURNOVER
Comprehensive Practice Examination
Total Questions: 150
SECTION 1: PERIOPERATIVE & INTRAOPERATIVE NURSING (Questions 1-20)
1. A patient is scheduled for surgery and is NPO. The patient asks, "Why can't I have water
before surgery?" What is the best response by the nurse?
A. "You might aspirate the water into your lungs during anesthesia"
B. "The water could dilute your blood and cause complications"
C. "We want to prevent you from needing to urinate during surgery"
D. "The water could interact with the anesthesia medications"
Answer: A. "You might aspirate the water into your lungs during anesthesia"
Rationale: NPO status before surgery is to prevent aspiration of gastric contents during
anesthesia induction. Aspiration can cause pneumonia, respiratory distress, and other
complications. The NPO period typically includes no food for 6-8 hours and no clear liquids for 2
hours before surgery depending on the type of surgery and anesthesia.
2. The nurse is preparing a patient for surgery. Which finding should be reported to the
surgeon immediately?
A. Blood pressure 140/90 mmHg
B. Temperature 99.8°F (37.7°C)
C. Serum potassium 5.8 mEq/L
D. Pulse 88 beats per minute
Answer: C. Serum potassium 5.8 mEq/L
Rationale: Hyperkalemia (K+ >5.5 mEq/L) increases the risk of cardiac arrhythmias during
surgery and anesthesia. This finding should be reported immediately for further evaluation and
management. The other findings are within normal or acceptable ranges and may not require
immediate reporting.
3. A patient is in the post-anesthesia care unit (PACU) following surgery. Which assessment
finding requires immediate intervention?
,A. Heart rate 88 bpm
B. Respiratory rate 12 breaths/min
C. Oxygen saturation 88% on room air
D. Blood pressure 110/70 mmHg
Answer: C. Oxygen saturation 88% on room air
Rationale: An oxygen saturation of 88% indicates hypoxemia requiring immediate intervention.
The nurse should assess the airway, provide supplemental oxygen, and notify the provider if the
saturation does not improve. The other vital signs are within normal ranges for a postoperative
patient.
4. A patient is receiving IV fluids during surgery. The nurse notes that the patient has
developed pulmonary edema. Which of the following is the priority nursing action?
A. Slow the IV infusion rate
B. Administer furosemide as prescribed
C. Place the patient in high Fowler's position
D. All of the above
Answer: D. All of the above
Rationale: When a patient develops pulmonary edema, the priority interventions include
slowing the IV infusion rate, administering diuretics as prescribed, and positioning the patient in
high Fowler's to facilitate breathing. All of these interventions are appropriate and should be
implemented promptly.
5. A patient is receiving general anesthesia. The nurse monitors for malignant hyperthermia.
Which of the following is an early sign of this complication?
A. Bradycardia
B. Hypothermia
C. Muscle rigidity and hyperthermia
D. Hypotension
Answer: C. Muscle rigidity and hyperthermia
Rationale: Malignant hyperthermia is a life-threatening complication of general anesthesia
characterized by muscle rigidity (especially masseter spasm), hyperthermia, tachycardia, and
metabolic acidosis. Early recognition and treatment with dantrolene sodium are essential.
Bradycardia, hypothermia, and hypotension are not early signs.
6. A patient is scheduled for a laparoscopic cholecystectomy. The nurse provides preoperative
teaching. Which statement by the patient indicates a need for further teaching?
,A. "I will have small incisions on my abdomen"
B. "I will need to cough and deep breathe after surgery"
C. "I will be able to return to normal activities the next day"
D. "I may have shoulder pain after surgery due to the gas used"
Answer: C. "I will be able to return to normal activities the next day"
Rationale: While laparoscopic surgery is less invasive, patients still need time to recover. Return
to normal activities typically takes 1-2 weeks. Patients should be educated about activity
restrictions, wound care, and signs of complications. Shoulder pain from carbon dioxide gas
used during laparoscopy is common and expected.
7. The nurse is caring for a patient immediately after surgery. The patient's urine output is 20
mL over 2 hours. What is the priority nursing action?
A. Document the finding
B. Notify the healthcare provider
C. Increase the IV fluid rate
D. Insert a Foley catheter
Answer: B. Notify the healthcare provider
Rationale: Adequate urine output postoperatively should be at least 30 mL/hour. A urine output
of 20 mL over 2 hours (10 mL/hour) is below acceptable limits and may indicate hypovolemia,
renal impairment, or obstruction. The provider should be notified immediately for further
evaluation and intervention.
8. A patient has a PCA (patient-controlled analgesia) pump for postoperative pain
management. The nurse notes that the patient is very drowsy and has a respiratory rate of 8
breaths/min. What is the priority nursing action?
A. Administer naloxone
B. Stop the PCA infusion
C. Stimulate the patient to breathe
D. Notify the healthcare provider
Answer: B. Stop the PCA infusion
Rationale: A respiratory rate of 8 breaths/min indicates respiratory depression from opioid
overdose. The priority is to stop the PCA infusion immediately to prevent further opioid
administration. After stopping the infusion, the nurse should assess the patient, stimulate
breathing, administer naloxone if ordered, and notify the provider.
, 9. A patient is being positioned for surgery in the lithotomy position. The nurse should
monitor for which potential complication?
A. Pressure injury on the heels
B. Nerve damage to the common peroneal nerve
C. Compartment syndrome of the lower extremities
D. All of the above
Answer: D. All of the above
Rationale: The lithotomy position (legs in stirrups) can cause pressure injuries on the heels,
common peroneal nerve damage (foot drop), and compartment syndrome due to prolonged
positioning. The nurse should monitor for these complications and ensure proper padding and
positioning.
10. The nurse is performing a preoperative assessment. Which medication should be reported
to the provider as a potential risk for increased bleeding?
A. Aspirin
B. Metoprolol
C. Lisinopril
D. Furosemide
Answer: A. Aspirin
Rationale: Aspirin is an antiplatelet agent that increases the risk of bleeding during surgery. It
should be reported to the provider and may need to be discontinued 5-7 days before surgery.
Beta-blockers, ACE inhibitors, and diuretics may also require adjustment but aspirin specifically
increases bleeding risk.
11. A patient is in the PACU after surgery. The patient reports feeling cold and has visible
shivering. Which nursing intervention is most appropriate?
A. Increase the room temperature
B. Administer warmed IV fluids
C. Provide warm blankets
D. All of the above
Answer: D. All of the above
Rationale: Postoperative shivering is common due to anesthesia-induced hypothermia.
Interventions include increasing room temperature, administering warmed IV fluids, and
providing warm blankets. The goal is to restore normothermia and reduce the metabolic
demand associated with shivering.
Q&A – NURSING-FOCUSED, HIGH TURNOVER
Comprehensive Practice Examination
Total Questions: 150
SECTION 1: PERIOPERATIVE & INTRAOPERATIVE NURSING (Questions 1-20)
1. A patient is scheduled for surgery and is NPO. The patient asks, "Why can't I have water
before surgery?" What is the best response by the nurse?
A. "You might aspirate the water into your lungs during anesthesia"
B. "The water could dilute your blood and cause complications"
C. "We want to prevent you from needing to urinate during surgery"
D. "The water could interact with the anesthesia medications"
Answer: A. "You might aspirate the water into your lungs during anesthesia"
Rationale: NPO status before surgery is to prevent aspiration of gastric contents during
anesthesia induction. Aspiration can cause pneumonia, respiratory distress, and other
complications. The NPO period typically includes no food for 6-8 hours and no clear liquids for 2
hours before surgery depending on the type of surgery and anesthesia.
2. The nurse is preparing a patient for surgery. Which finding should be reported to the
surgeon immediately?
A. Blood pressure 140/90 mmHg
B. Temperature 99.8°F (37.7°C)
C. Serum potassium 5.8 mEq/L
D. Pulse 88 beats per minute
Answer: C. Serum potassium 5.8 mEq/L
Rationale: Hyperkalemia (K+ >5.5 mEq/L) increases the risk of cardiac arrhythmias during
surgery and anesthesia. This finding should be reported immediately for further evaluation and
management. The other findings are within normal or acceptable ranges and may not require
immediate reporting.
3. A patient is in the post-anesthesia care unit (PACU) following surgery. Which assessment
finding requires immediate intervention?
,A. Heart rate 88 bpm
B. Respiratory rate 12 breaths/min
C. Oxygen saturation 88% on room air
D. Blood pressure 110/70 mmHg
Answer: C. Oxygen saturation 88% on room air
Rationale: An oxygen saturation of 88% indicates hypoxemia requiring immediate intervention.
The nurse should assess the airway, provide supplemental oxygen, and notify the provider if the
saturation does not improve. The other vital signs are within normal ranges for a postoperative
patient.
4. A patient is receiving IV fluids during surgery. The nurse notes that the patient has
developed pulmonary edema. Which of the following is the priority nursing action?
A. Slow the IV infusion rate
B. Administer furosemide as prescribed
C. Place the patient in high Fowler's position
D. All of the above
Answer: D. All of the above
Rationale: When a patient develops pulmonary edema, the priority interventions include
slowing the IV infusion rate, administering diuretics as prescribed, and positioning the patient in
high Fowler's to facilitate breathing. All of these interventions are appropriate and should be
implemented promptly.
5. A patient is receiving general anesthesia. The nurse monitors for malignant hyperthermia.
Which of the following is an early sign of this complication?
A. Bradycardia
B. Hypothermia
C. Muscle rigidity and hyperthermia
D. Hypotension
Answer: C. Muscle rigidity and hyperthermia
Rationale: Malignant hyperthermia is a life-threatening complication of general anesthesia
characterized by muscle rigidity (especially masseter spasm), hyperthermia, tachycardia, and
metabolic acidosis. Early recognition and treatment with dantrolene sodium are essential.
Bradycardia, hypothermia, and hypotension are not early signs.
6. A patient is scheduled for a laparoscopic cholecystectomy. The nurse provides preoperative
teaching. Which statement by the patient indicates a need for further teaching?
,A. "I will have small incisions on my abdomen"
B. "I will need to cough and deep breathe after surgery"
C. "I will be able to return to normal activities the next day"
D. "I may have shoulder pain after surgery due to the gas used"
Answer: C. "I will be able to return to normal activities the next day"
Rationale: While laparoscopic surgery is less invasive, patients still need time to recover. Return
to normal activities typically takes 1-2 weeks. Patients should be educated about activity
restrictions, wound care, and signs of complications. Shoulder pain from carbon dioxide gas
used during laparoscopy is common and expected.
7. The nurse is caring for a patient immediately after surgery. The patient's urine output is 20
mL over 2 hours. What is the priority nursing action?
A. Document the finding
B. Notify the healthcare provider
C. Increase the IV fluid rate
D. Insert a Foley catheter
Answer: B. Notify the healthcare provider
Rationale: Adequate urine output postoperatively should be at least 30 mL/hour. A urine output
of 20 mL over 2 hours (10 mL/hour) is below acceptable limits and may indicate hypovolemia,
renal impairment, or obstruction. The provider should be notified immediately for further
evaluation and intervention.
8. A patient has a PCA (patient-controlled analgesia) pump for postoperative pain
management. The nurse notes that the patient is very drowsy and has a respiratory rate of 8
breaths/min. What is the priority nursing action?
A. Administer naloxone
B. Stop the PCA infusion
C. Stimulate the patient to breathe
D. Notify the healthcare provider
Answer: B. Stop the PCA infusion
Rationale: A respiratory rate of 8 breaths/min indicates respiratory depression from opioid
overdose. The priority is to stop the PCA infusion immediately to prevent further opioid
administration. After stopping the infusion, the nurse should assess the patient, stimulate
breathing, administer naloxone if ordered, and notify the provider.
, 9. A patient is being positioned for surgery in the lithotomy position. The nurse should
monitor for which potential complication?
A. Pressure injury on the heels
B. Nerve damage to the common peroneal nerve
C. Compartment syndrome of the lower extremities
D. All of the above
Answer: D. All of the above
Rationale: The lithotomy position (legs in stirrups) can cause pressure injuries on the heels,
common peroneal nerve damage (foot drop), and compartment syndrome due to prolonged
positioning. The nurse should monitor for these complications and ensure proper padding and
positioning.
10. The nurse is performing a preoperative assessment. Which medication should be reported
to the provider as a potential risk for increased bleeding?
A. Aspirin
B. Metoprolol
C. Lisinopril
D. Furosemide
Answer: A. Aspirin
Rationale: Aspirin is an antiplatelet agent that increases the risk of bleeding during surgery. It
should be reported to the provider and may need to be discontinued 5-7 days before surgery.
Beta-blockers, ACE inhibitors, and diuretics may also require adjustment but aspirin specifically
increases bleeding risk.
11. A patient is in the PACU after surgery. The patient reports feeling cold and has visible
shivering. Which nursing intervention is most appropriate?
A. Increase the room temperature
B. Administer warmed IV fluids
C. Provide warm blankets
D. All of the above
Answer: D. All of the above
Rationale: Postoperative shivering is common due to anesthesia-induced hypothermia.
Interventions include increasing room temperature, administering warmed IV fluids, and
providing warm blankets. The goal is to restore normothermia and reduce the metabolic
demand associated with shivering.
