NUR 265 – Medical-Surgical Nursing Exam 1 – Galen College of Nursing 2026/2027 | Verified Answers
NUR 265 — EXAM 1: MEDICAL-SURGICAL NURSING
Galen College of Nursing — 2026/2027
Verified Answers with Detailed Rationales — 100% Correct
Total Questions 110 (Q1–Q110)
Number of Sections 7
Cognitive Levels ~30% Recall · ~50% Application · ~20% Analysis
Question Style 75% Scenario-based · 25% Direct recall of pathophysiology/medications
Answer Format 4-option multiple choice (A–D), one correct answer
Coverage Perioperative, fluids/ABG, cardiac, hematologic, respiratory, MSK/integ, safety
Verification Each rationale confirms the answer against current medical-surgical nursing standards
This exam is aligned with the current Galen College of Nursing NUR 265 Medical-Surgical Nursing Exam 1 blueprint
and reflects 2026/2027 updated clinical practice standards, CDC isolation guidance, ACC/AHA hypertension
guidelines, NPIAP pressure injury staging, and ISMP high-alert medication safety practices. Questions are sequenced
across seven sections covering perioperative care, fluid/electrolyte/acid-base balance, cardiovascular and hematologic
disorders, respiratory disorders (including chest tube management), musculoskeletal/integumentary disorders, and
nursing safety/prioritization. Each question includes a detailed rationale explaining why the correct answer is right and
why each distractor is wrong, citing the relevant pathophysiologic basis, assessment finding, nursing intervention, or
safety priority. Distractors are constructed to surface common medical-surgical nursing errors, including: confusing
fluid and electrolyte imbalances (hyperkalemia vs. hypokalemia); misinterpreting ABG results and compensation;
incorrect prioritization of unstable clients (ABC, Maslow); overlooking postoperative complications (malignant
hyperthermia, wound dehiscence/evisceration, compartment syndrome); misidentifying transfusion reactions (acute
hemolytic vs. allergic vs. TACO); improper high-alert medication administration (insulin, heparin, opioids); and
misapplying isolation precautions (airborne vs. droplet vs. contact; C. diff requires soap and water). Use this exam as
both a graded assessment preparation tool and a comprehensive study guide.
Section 1: Perioperative Nursing Care
Q1–Q18 — Preoperative, Intraoperative, & Postoperative Phases (Informed consent, NPO, sterile technique, PACU,
malignant hyperthermia, wound dehiscence/evisceration).
NUR 265 – Verified Answers Page 1
,NUR 265 – Medical-Surgical Nursing Exam 1 – Galen College of Nursing 2026/2027 | Verified Answers
Q1: A 67-year-old male is scheduled for an elective cholecystectomy. The nurse is reviewing the
preoperative checklist. Which finding requires the nurse to notify the surgeon and anesthesia provider
BEFORE proceeding with surgery? [Competency: Perioperative – Preoperative Assessment]
A. The patient took his morning dose of metoprolol with a sip of water as ordered.
B. The patient reports a previous reaction of “hives and swelling” after receiving IV contrast dye.
[CORRECT]
C. The patient signed the surgical consent form 24 hours ago after the surgeon explained risks and benefits.
D. The patient has an IV line infusing lactated Ringer’s at 75 mL/hr.
Correct Answer: B
Rationale: A history of contrast dye reaction suggests potential allergy to substances used perioperatively and may
indicate increased risk of anaphylaxis to anesthesia medications or other agents; the surgeon and anesthesia provider
must be notified before proceeding. Beta-blockers are typically continued preoperatively (A). Signed consent with
explanation is appropriate (C). An infusing IV is expected preoperatively (D). Verified against current AORN and ASA
perioperative standards.
Q2: A nurse is preparing to witness a surgical consent for a 52-year-old female scheduled for a total
abdominal hysterectomy. Which situation would render the consent INVALID? [Competency:
Perioperative – Informed Consent]
A. The patient received a sedative medication 30 minutes before signing the consent. [CORRECT]
B. The surgeon explained the procedure, risks, benefits, and alternatives 2 hours ago.
C. The patient signed the consent voluntarily without coercion.
D. The patient’s spouse is present in the room but not influencing the decision.
Correct Answer: A
Rationale: Valid informed consent requires the patient to be competent and not under the influence of sedating
medications that impair cognition. A consent signed after sedation is invalid. Explanation of
procedure/risks/benefits/alternatives supports validity (B). Voluntary signature supports validity (C). A non-coercive
spouse’s presence does not invalidate consent (D). Verified against perioperative consent principles.
Q3: A nurse is teaching a patient scheduled for surgery about postoperative deep breathing and incentive
spirometry. Which statement by the patient indicates the teaching has been EFFECTIVE? [Competency:
Perioperative – Postoperative Respiratory Care]
A. “I will use the incentive spirometer once every 8 hours while awake.”
B. “I will use the incentive spirometer 10 times every hour while awake.” [CORRECT]
C. “I will use the incentive spirometer only if I feel short of breath.”
D. “I will hold my breath briefly at the peak of inhalation to maximize lung expansion.”
Correct Answer: B
Rationale: Incentive spirometry should be performed approximately 10 times every hour while awake to prevent
atelectasis. Once every 8 hours is insufficient (A). PRN-only use does not prevent atelectasis (C). While breath-holding
at peak inspiration is part of the technique, the frequency of 10 times per hour is the most critical evidence-based
practice (D is technique; B is frequency). Verified against AARC perioperative breathing standards.
NUR 265 – Verified Answers Page 2
,NUR 265 – Medical-Surgical Nursing Exam 1 – Galen College of Nursing 2026/2027 | Verified Answers
Q4: A patient is admitted to the PACU following general anesthesia. Which finding requires the nurse’s
FIRST action? [Competency: Perioperative – PACU Prioritization]
A. Oxygen saturation 88% on room air with shallow respirations of 10/min. [CORRECT]
B. Blood pressure 100/60 mmHg with heart rate 88/min.
C. Surgical drainage 75 mL in the first hour.
D. Patient groaning and reports pain at 8/10.
Correct Answer: A
Rationale: Per the ABC framework, oxygen saturation of 88% with shallow respirations indicates airway/breathing
compromise and requires immediate intervention. BP 100/60 with HR 88 is acceptable postoperatively (B). Drainage of
75 mL in the first hour is within expected limits (C). Pain requires intervention but after airway (D). Verified against
PACU prioritization (ABC).
Q5: A patient received general anesthesia 30 minutes ago and is shivering vigorously in the PACU. Which
action is MOST appropriate? [Competency: Perioperative – Postoperative Shivering]
A. Apply warm blankets and monitor core temperature; administer warmed IV fluids if ordered.
[CORRECT]
B. Administer naloxone immediately.
C. Place the patient in Trendelenburg position.
D. Restrict all fluid intake until shivering resolves.
Correct Answer: A
Rationale: Postanesthetic shivering is common due to hypothermia from anesthesia and cool OR environment;
treatment includes warm blankets, warmed IV fluids, and monitoring. Naloxone reverses opioids (B). Trendelenburg has
no role in shivering (C). Fluid restriction is inappropriate (D). Verified against PACU hypothermia management.
Q6: Which patient is at HIGHEST risk for malignant hyperthermia during surgery? [Competency:
Perioperative – Malignant Hyperthermia]
A. A 22-year-old with a family history of malignant hyperthermia scheduled for an elective hernia repair
with succinylcholine. [CORRECT]
B. A 65-year-old with hypertension scheduled for cataract surgery under local anesthesia.
C. A 50-year-old with type 2 diabetes scheduled for an appendectomy with propofol.
D. A 30-year-old with asthma scheduled for a tonsillectomy with sevoflurane.
Correct Answer: A
Rationale: Malignant hyperthermia is a genetic hypermetabolic crisis triggered by succinylcholine and inhaled
anesthetics (e.g., sevoflurane); a family history is the strongest risk factor. Local anesthesia without triggering agents
carries minimal risk (B). Propofol does not trigger MH (C). Asthma alone is not a risk factor, though sevoflurane is a
trigger — the family history in option A makes it the strongest risk (D). Verified against MHAUS standards.
NUR 265 – Verified Answers Page 3
, NUR 265 – Medical-Surgical Nursing Exam 1 – Galen College of Nursing 2026/2027 | Verified Answers
Q7: A patient in the PACU develops muscle rigidity, temperature 104°F (40°C), tachycardia,
andtachypnea. Which medication MUST the nurse administer immediately? [Competency: Perioperative –
Malignant Hyperthermia Treatment]
A. Dantrolene 2.5 mg/kg IV. [CORRECT]
B. Acetaminophen 1000 mg IV.
C. Fentanyl 50 mcg IV.
D. Atropine 0.5 mg IV.
Correct Answer: A
Rationale: These findings (hyperthermia, muscle rigidity, tachycardia, tachypnea) are classic for malignant
hyperthermia; immediate IV dantrolene is the life-saving antidote by inhibiting calcium release from skeletal muscle.
Acetaminophen is inadequate for MH (B). Fentanyl worsens hypercapnia (C). Atropine worsens tachycardia (D).
Verified against MHAUS treatment guidelines.
Q8: A postoperative patient (post-op day 2) reports sudden pleuritic chest pain, dyspnea, and a dry cough.
The nurse notes tachycardia and low-grade fever. Which complication is MOST likely? [Competency:
Perioperative – Postoperative Complications]
A. Pulmonary embolism. [CORRECT]
B. Atelectasis.
C. Wound dehiscence.
D. Malignant hyperthermia.
Correct Answer: A
Rationale: Pleuritic chest pain, dyspnea, dry cough, tachycardia, and low-grade fever in a postoperative patient suggest
pulmonary embolism, a life-threatening complication. Atelectasis typically presents with mild fever without pleuritic
chest pain (B). Wound dehiscence is a wound complication (C). Malignant hyperthermia occurs intraoperatively (D).
Verified against AHCPR postoperative PE recognition.
Q9: Which intervention is MOST effective in preventing postoperative DVT in a surgical patient?
[Competency: Perioperative – DVT Prevention]
A. Early ambulation, use of sequential compression devices (SCDs), and administration of prophylactic
anticoagulation if ordered. [CORRECT]
B. Strict bed rest for 72 hours postoperatively.
C. Encouraging deep breathing every 4 hours.
D. Limiting oral fluid intake to 1000 mL/day.
Correct Answer: A
Rationale: Early ambulation, SCDs, and prophylactic anticoagulation are evidence-based DVT prevention measures.
Bed rest increases DVT risk (B). Deep breathing prevents atelectasis, not DVT (C). Fluid restriction increases venous
stasis and DVT risk (D). Verified against ACCP postoperative VTE prevention guidelines.
NUR 265 – Verified Answers Page 4
NUR 265 — EXAM 1: MEDICAL-SURGICAL NURSING
Galen College of Nursing — 2026/2027
Verified Answers with Detailed Rationales — 100% Correct
Total Questions 110 (Q1–Q110)
Number of Sections 7
Cognitive Levels ~30% Recall · ~50% Application · ~20% Analysis
Question Style 75% Scenario-based · 25% Direct recall of pathophysiology/medications
Answer Format 4-option multiple choice (A–D), one correct answer
Coverage Perioperative, fluids/ABG, cardiac, hematologic, respiratory, MSK/integ, safety
Verification Each rationale confirms the answer against current medical-surgical nursing standards
This exam is aligned with the current Galen College of Nursing NUR 265 Medical-Surgical Nursing Exam 1 blueprint
and reflects 2026/2027 updated clinical practice standards, CDC isolation guidance, ACC/AHA hypertension
guidelines, NPIAP pressure injury staging, and ISMP high-alert medication safety practices. Questions are sequenced
across seven sections covering perioperative care, fluid/electrolyte/acid-base balance, cardiovascular and hematologic
disorders, respiratory disorders (including chest tube management), musculoskeletal/integumentary disorders, and
nursing safety/prioritization. Each question includes a detailed rationale explaining why the correct answer is right and
why each distractor is wrong, citing the relevant pathophysiologic basis, assessment finding, nursing intervention, or
safety priority. Distractors are constructed to surface common medical-surgical nursing errors, including: confusing
fluid and electrolyte imbalances (hyperkalemia vs. hypokalemia); misinterpreting ABG results and compensation;
incorrect prioritization of unstable clients (ABC, Maslow); overlooking postoperative complications (malignant
hyperthermia, wound dehiscence/evisceration, compartment syndrome); misidentifying transfusion reactions (acute
hemolytic vs. allergic vs. TACO); improper high-alert medication administration (insulin, heparin, opioids); and
misapplying isolation precautions (airborne vs. droplet vs. contact; C. diff requires soap and water). Use this exam as
both a graded assessment preparation tool and a comprehensive study guide.
Section 1: Perioperative Nursing Care
Q1–Q18 — Preoperative, Intraoperative, & Postoperative Phases (Informed consent, NPO, sterile technique, PACU,
malignant hyperthermia, wound dehiscence/evisceration).
NUR 265 – Verified Answers Page 1
,NUR 265 – Medical-Surgical Nursing Exam 1 – Galen College of Nursing 2026/2027 | Verified Answers
Q1: A 67-year-old male is scheduled for an elective cholecystectomy. The nurse is reviewing the
preoperative checklist. Which finding requires the nurse to notify the surgeon and anesthesia provider
BEFORE proceeding with surgery? [Competency: Perioperative – Preoperative Assessment]
A. The patient took his morning dose of metoprolol with a sip of water as ordered.
B. The patient reports a previous reaction of “hives and swelling” after receiving IV contrast dye.
[CORRECT]
C. The patient signed the surgical consent form 24 hours ago after the surgeon explained risks and benefits.
D. The patient has an IV line infusing lactated Ringer’s at 75 mL/hr.
Correct Answer: B
Rationale: A history of contrast dye reaction suggests potential allergy to substances used perioperatively and may
indicate increased risk of anaphylaxis to anesthesia medications or other agents; the surgeon and anesthesia provider
must be notified before proceeding. Beta-blockers are typically continued preoperatively (A). Signed consent with
explanation is appropriate (C). An infusing IV is expected preoperatively (D). Verified against current AORN and ASA
perioperative standards.
Q2: A nurse is preparing to witness a surgical consent for a 52-year-old female scheduled for a total
abdominal hysterectomy. Which situation would render the consent INVALID? [Competency:
Perioperative – Informed Consent]
A. The patient received a sedative medication 30 minutes before signing the consent. [CORRECT]
B. The surgeon explained the procedure, risks, benefits, and alternatives 2 hours ago.
C. The patient signed the consent voluntarily without coercion.
D. The patient’s spouse is present in the room but not influencing the decision.
Correct Answer: A
Rationale: Valid informed consent requires the patient to be competent and not under the influence of sedating
medications that impair cognition. A consent signed after sedation is invalid. Explanation of
procedure/risks/benefits/alternatives supports validity (B). Voluntary signature supports validity (C). A non-coercive
spouse’s presence does not invalidate consent (D). Verified against perioperative consent principles.
Q3: A nurse is teaching a patient scheduled for surgery about postoperative deep breathing and incentive
spirometry. Which statement by the patient indicates the teaching has been EFFECTIVE? [Competency:
Perioperative – Postoperative Respiratory Care]
A. “I will use the incentive spirometer once every 8 hours while awake.”
B. “I will use the incentive spirometer 10 times every hour while awake.” [CORRECT]
C. “I will use the incentive spirometer only if I feel short of breath.”
D. “I will hold my breath briefly at the peak of inhalation to maximize lung expansion.”
Correct Answer: B
Rationale: Incentive spirometry should be performed approximately 10 times every hour while awake to prevent
atelectasis. Once every 8 hours is insufficient (A). PRN-only use does not prevent atelectasis (C). While breath-holding
at peak inspiration is part of the technique, the frequency of 10 times per hour is the most critical evidence-based
practice (D is technique; B is frequency). Verified against AARC perioperative breathing standards.
NUR 265 – Verified Answers Page 2
,NUR 265 – Medical-Surgical Nursing Exam 1 – Galen College of Nursing 2026/2027 | Verified Answers
Q4: A patient is admitted to the PACU following general anesthesia. Which finding requires the nurse’s
FIRST action? [Competency: Perioperative – PACU Prioritization]
A. Oxygen saturation 88% on room air with shallow respirations of 10/min. [CORRECT]
B. Blood pressure 100/60 mmHg with heart rate 88/min.
C. Surgical drainage 75 mL in the first hour.
D. Patient groaning and reports pain at 8/10.
Correct Answer: A
Rationale: Per the ABC framework, oxygen saturation of 88% with shallow respirations indicates airway/breathing
compromise and requires immediate intervention. BP 100/60 with HR 88 is acceptable postoperatively (B). Drainage of
75 mL in the first hour is within expected limits (C). Pain requires intervention but after airway (D). Verified against
PACU prioritization (ABC).
Q5: A patient received general anesthesia 30 minutes ago and is shivering vigorously in the PACU. Which
action is MOST appropriate? [Competency: Perioperative – Postoperative Shivering]
A. Apply warm blankets and monitor core temperature; administer warmed IV fluids if ordered.
[CORRECT]
B. Administer naloxone immediately.
C. Place the patient in Trendelenburg position.
D. Restrict all fluid intake until shivering resolves.
Correct Answer: A
Rationale: Postanesthetic shivering is common due to hypothermia from anesthesia and cool OR environment;
treatment includes warm blankets, warmed IV fluids, and monitoring. Naloxone reverses opioids (B). Trendelenburg has
no role in shivering (C). Fluid restriction is inappropriate (D). Verified against PACU hypothermia management.
Q6: Which patient is at HIGHEST risk for malignant hyperthermia during surgery? [Competency:
Perioperative – Malignant Hyperthermia]
A. A 22-year-old with a family history of malignant hyperthermia scheduled for an elective hernia repair
with succinylcholine. [CORRECT]
B. A 65-year-old with hypertension scheduled for cataract surgery under local anesthesia.
C. A 50-year-old with type 2 diabetes scheduled for an appendectomy with propofol.
D. A 30-year-old with asthma scheduled for a tonsillectomy with sevoflurane.
Correct Answer: A
Rationale: Malignant hyperthermia is a genetic hypermetabolic crisis triggered by succinylcholine and inhaled
anesthetics (e.g., sevoflurane); a family history is the strongest risk factor. Local anesthesia without triggering agents
carries minimal risk (B). Propofol does not trigger MH (C). Asthma alone is not a risk factor, though sevoflurane is a
trigger — the family history in option A makes it the strongest risk (D). Verified against MHAUS standards.
NUR 265 – Verified Answers Page 3
, NUR 265 – Medical-Surgical Nursing Exam 1 – Galen College of Nursing 2026/2027 | Verified Answers
Q7: A patient in the PACU develops muscle rigidity, temperature 104°F (40°C), tachycardia,
andtachypnea. Which medication MUST the nurse administer immediately? [Competency: Perioperative –
Malignant Hyperthermia Treatment]
A. Dantrolene 2.5 mg/kg IV. [CORRECT]
B. Acetaminophen 1000 mg IV.
C. Fentanyl 50 mcg IV.
D. Atropine 0.5 mg IV.
Correct Answer: A
Rationale: These findings (hyperthermia, muscle rigidity, tachycardia, tachypnea) are classic for malignant
hyperthermia; immediate IV dantrolene is the life-saving antidote by inhibiting calcium release from skeletal muscle.
Acetaminophen is inadequate for MH (B). Fentanyl worsens hypercapnia (C). Atropine worsens tachycardia (D).
Verified against MHAUS treatment guidelines.
Q8: A postoperative patient (post-op day 2) reports sudden pleuritic chest pain, dyspnea, and a dry cough.
The nurse notes tachycardia and low-grade fever. Which complication is MOST likely? [Competency:
Perioperative – Postoperative Complications]
A. Pulmonary embolism. [CORRECT]
B. Atelectasis.
C. Wound dehiscence.
D. Malignant hyperthermia.
Correct Answer: A
Rationale: Pleuritic chest pain, dyspnea, dry cough, tachycardia, and low-grade fever in a postoperative patient suggest
pulmonary embolism, a life-threatening complication. Atelectasis typically presents with mild fever without pleuritic
chest pain (B). Wound dehiscence is a wound complication (C). Malignant hyperthermia occurs intraoperatively (D).
Verified against AHCPR postoperative PE recognition.
Q9: Which intervention is MOST effective in preventing postoperative DVT in a surgical patient?
[Competency: Perioperative – DVT Prevention]
A. Early ambulation, use of sequential compression devices (SCDs), and administration of prophylactic
anticoagulation if ordered. [CORRECT]
B. Strict bed rest for 72 hours postoperatively.
C. Encouraging deep breathing every 4 hours.
D. Limiting oral fluid intake to 1000 mL/day.
Correct Answer: A
Rationale: Early ambulation, SCDs, and prophylactic anticoagulation are evidence-based DVT prevention measures.
Bed rest increases DVT risk (B). Deep breathing prevents atelectasis, not DVT (C). Fluid restriction increases venous
stasis and DVT risk (D). Verified against ACCP postoperative VTE prevention guidelines.
NUR 265 – Verified Answers Page 4
