NUR 265 Medical-Surgical Nursing | Final Examination 2026/2027 Galen College of Nursing
GALEN COLLEGE OF NURSING
NUR 265: Medical-Surgical Nursing
Final Examination - Comprehensive Practice Exam
2026/2027 Academic Cycle
150 Questions | 10 Sections | Answers & Rationales Included | Cumulative Coverage of Exam 1, Exam 2, and Exam 3
Content
Examination Overview and Instructions
DIRECTIONS: Select the single best answer (A-D) for each of the 150 multiple-choice questions. The correct option
is tagged [CORRECT] and is followed by a rationale explaining the underlying pathophysiology, nursing interventions,
and clinical judgment principles, including why the distractors are incorrect. Questions integrate prioritization
frameworks (ABCs, Maslow, safety), delegation and supervision (RN, LPN, UAP scope), laboratory value
interpretation, medication calculation and management, patient education, infection control, and NCLEX Next
Generation style clinical judgment scenarios. Distribution reflects NUR 265 cognitive leveling: approximately 25%
recall, 55% application, and 20% analysis.
SECTION 1
Section 1: Perioperative Nursing Care
Preoperative, Intraoperative, Postoperative, & Anesthesia Complications
Q1: A client scheduled for an open cholecystectomy tells the nurse, "I still don't understand what they are
going to do during my surgery." Which action should the nurse take first?
A. Ask the client to sign the consent form so that surgery is not delayed
B. Notify the surgeon that the client needs further explanation before consent is obtained [CORRECT]
C. Provide the client with an educational brochure about cholecystectomy
D. Ask a family member to explain the procedure to the client
Correct Answer: B
Rationale: Informed consent requires that the surgeon (the person performing the procedure) disclose the nature,
risks, and alternatives of the surgery. When the client lacks understanding, the nurse acts as a client advocate by
notifying the surgeon rather than allowing an uninformed signature, which would invalidate the consent and create a
legal liability. A brochure may supplement teaching but does not satisfy the legal disclosure requirement, and
delegating the explanation to family is neither ethical nor legally valid.
1
,NUR 265 Medical-Surgical Nursing | Final Examination 2026/2027 Galen College of Nursing
Q2: The nurse is reviewing the morning medication list for a client scheduled for abdominal surgery at
0800. Which medication order should the nurse clarify with the surgeon before the client goes to the
operating room?
A. Metoprolol 50 mg orally with a sip of water
B. Levothyroxine 100 mcg orally with a sip of water
C. Warfarin 5 mg orally on the morning of surgery [CORRECT]
D. Phenytoin 200 mg orally with a sip of water
Correct Answer: C
Rationale: Warfarin is an anticoagulant that significantly increases intraoperative and postoperative bleeding risk
and is normally discontinued about five days before surgery, sometimes with bridging therapy. Beta blockers,
levothyroxine, and antiseizure medications are typically continued on the day of surgery with a sip of water because
abruptly withholding them can cause rebound hypertension, dysrhythmias, thyroid storm, or seizures.
Q3: A preoperative client states, "The nurse told me to use that breathing gadget after surgery." Which
client statement indicates correct understanding of the purpose of incentive spirometry?
A. "It will help me breathe in medicated mist to open my airways."
B. "It will measure how much air I can blow out of my lungs."
C. "It will deliver oxygen while I sleep so I don't desaturate."
D. "It will help keep my small air sacs open so I don't get pneumonia." [CORRECT]
Correct Answer: D
Rationale: Incentive spirometry promotes sustained maximal inspiration, which inflates alveoli and prevents
alveolar collapse (atelectasis), the most common postoperative pulmonary complication caused by general
anesthesia, pain-limited breathing, and retained secretions. Nebulized mist, expiratory measurement, and
supplemental oxygen describe nebulizers, peak flow meters, and oxygen therapy, none of which prevent atelectasis.
Q4: A client arrives in the postanesthesia care unit (PACU) following an abdominal hysterectomy
performed under general anesthesia. Which assessment is the nurse's first priority?
A. Airway patency and respiratory rate, depth, and oxygen saturation [CORRECT]
B. Amount and character of drainage on the surgical dressing
C. Level of pain using the numeric rating scale
D. Hourly urinary output from the indwelling catheter
Correct Answer: A
Rationale: Prioritization follows the ABC framework: general anesthesia suppresses protective airway reflexes and
respiratory drive, so airway obstruction, laryngospasm, and hypoxemia are the earliest life-threatening postoperative
risks. Dressing drainage, pain, and urinary output are important assessments that follow once oxygenation and
ventilation are confirmed to be stable.
2
,NUR 265 Medical-Surgical Nursing | Final Examination 2026/2027 Galen College of Nursing
Q5: During an inguinal hernia repair under general anesthesia, the client develops tachycardia,
generalized muscle rigidity, and a rapidly rising end-tidal CO2; temperature is now 38.9 C (102 F).
Which intervention is the priority?
A. Apply a cooling blanket and continue close observation
B. Administer naloxone to reverse the anesthetic agents
C. Prepare and administer dantrolene sodium immediately [CORRECT]
D. Increase the concentration of the volatile anesthetic gas
Correct Answer: C
Rationale: These findings indicate malignant hyperthermia, a hypermetabolic crisis triggered by volatile anesthetic
agents and succinylcholine that causes uncontrolled skeletal muscle calcium release, rigidity, and extreme heat and
CO2 production. Dantrolene reverses the abnormal muscle metabolism and is the definitive treatment; cooling
measures are only adjunctive, naloxone does not reverse anesthetic triggers, and additional volatile agent would
worsen the crisis. Late temperature elevation means waiting for fever risks death.
Q6: A client who received spinal anesthesia reports a throbbing frontal headache that worsens when
sitting upright and improves when lying flat. Which nursing intervention is most appropriate?
A. Encourage increased oral fluids and maintain the client flat with the head slightly lowered
B. Seat the client upright at 90 degrees to decrease intracranial pressure [CORRECT]
C. Ambulate the client in the hallway to promote cerebral circulation
D. Restrict fluids to prevent cerebral edema and worsening headache
Correct Answer: B
Rationale: A post-dural puncture headache results from leakage of cerebrospinal fluid through the dural puncture
site, causing traction on pain-sensitive structures that is positional and relieved when supine. Hydration and flat
positioning promote CSF production and reduce the leak gradient, while an epidural blood patch may be performed
by the anesthesia provider if conservative measures fail. Upright positioning and ambulation worsen the leak, and
fluid restriction aggravates the deficit.
Q7: The nurse is planning care for a client on the first postoperative day following hip replacement
surgery. Which intervention is most effective in preventing venous thromboembolism?
A. Massaging the calves gently twice per shift to promote circulation
B. Placing pillows under the knees to elevate the extremities
C. Applying compression stockings only while the client is ambulating
D. Encouraging early, frequent ambulation with adequate hydration [CORRECT]
Correct Answer: D
Rationale: Early ambulation is the single most effective measure against venous thromboembolism because it
directly counteracts all components of Virchow's triad: venous stasis, endothelial injury, and hypercoagulability. Leg
massage can dislodge an existing thrombus into a pulmonary embolism, pillows under the knees compress popliteal
veins and impede return, and compression stockings should be worn throughout the immobile period rather than
only during ambulation.
3
, NUR 265 Medical-Surgical Nursing | Final Examination 2026/2027 Galen College of Nursing
Q8: Three days after an abdominal surgery, a client coughs forcefully and suddenly cries out that
"something gave way." The nurse observes protrusion of glistening, pinkish bowel through the incision.
Which action should the nurse take first?
A. Attempt to gently reinsert the protruding tissue into the abdomen
B. Cover the exposed bowel with sterile gauze moistened with sterile saline [CORRECT]
C. Instruct the client to splint the incision and cough deeply to expel secretions
D. Remove the remaining dressing to fully visualize the entire wound
Correct Answer: B
Rationale: Wound evisceration with exposed viscera is a surgical emergency; covering the bowel with sterile
saline-moistened gauze prevents desiccation and bacterial contamination while the client is placed in low Fowler
position with knees flexed and the surgeon is notified immediately. Repositioning bowel back into the abdomen
causes perforation and peritonitis, deep coughing worsens the dehiscence, and removing the dressing increases
contamination without benefit.
Q9: The surgical team is preparing to begin an elective laparoscopic appendectomy. Which action by the
circulating nurse best demonstrates adherence to the Universal Protocol surgical safety checklist?
A. Conducting a time-out to verify the correct client, procedure, and surgical site with all team members
[CORRECT]
B. Counting sponges and instruments only after the incision is closed
C. Confirming the client's insurance authorization before anesthesia induction
D. Marking the surgical site in the preoperative holding area alone without team verification
Correct Answer: A
Rationale: The Universal Protocol requires a time-out performed immediately before incision in which the entire
team actively verifies client identity, correct procedure, correct site, and imaging, with any team member
empowered to stop the procedure. Sponge counts are performed before, during, and after surgery rather than only at
closure, insurance verification is an administrative function unrelated to safety, and site marking alone does not
replace team verification.
Q10: A postoperative client has abdominal distention, absent bowel sounds in all quadrants, no passage of
flatus, and moderate nausea. Which prescription should the nurse anticipate implementing first?
A. Advance the diet to clear liquids to stimulate peristalsis
B. Administer a bisacodyl suppository to stimulate defecation
C. Keep the client NPO and insert a nasogastric tube to low intermittent suction [CORRECT]
D. Encourage the client to chew gum twice daily to activate the gastrocolic reflex
Correct Answer: C
Rationale: These findings indicate paralytic ileus, in which bowel motility is absent; the priorities are
decompression of the distended intestine via nasogastric suction, NPO status to rest the bowel, and intravenous
fluids to correct volume losses. Feeding an obstructed, nonfunctioning bowel, administering laxatives, or chewing
gum will not resolve distention and may precipitate vomiting and aspiration.
4
GALEN COLLEGE OF NURSING
NUR 265: Medical-Surgical Nursing
Final Examination - Comprehensive Practice Exam
2026/2027 Academic Cycle
150 Questions | 10 Sections | Answers & Rationales Included | Cumulative Coverage of Exam 1, Exam 2, and Exam 3
Content
Examination Overview and Instructions
DIRECTIONS: Select the single best answer (A-D) for each of the 150 multiple-choice questions. The correct option
is tagged [CORRECT] and is followed by a rationale explaining the underlying pathophysiology, nursing interventions,
and clinical judgment principles, including why the distractors are incorrect. Questions integrate prioritization
frameworks (ABCs, Maslow, safety), delegation and supervision (RN, LPN, UAP scope), laboratory value
interpretation, medication calculation and management, patient education, infection control, and NCLEX Next
Generation style clinical judgment scenarios. Distribution reflects NUR 265 cognitive leveling: approximately 25%
recall, 55% application, and 20% analysis.
SECTION 1
Section 1: Perioperative Nursing Care
Preoperative, Intraoperative, Postoperative, & Anesthesia Complications
Q1: A client scheduled for an open cholecystectomy tells the nurse, "I still don't understand what they are
going to do during my surgery." Which action should the nurse take first?
A. Ask the client to sign the consent form so that surgery is not delayed
B. Notify the surgeon that the client needs further explanation before consent is obtained [CORRECT]
C. Provide the client with an educational brochure about cholecystectomy
D. Ask a family member to explain the procedure to the client
Correct Answer: B
Rationale: Informed consent requires that the surgeon (the person performing the procedure) disclose the nature,
risks, and alternatives of the surgery. When the client lacks understanding, the nurse acts as a client advocate by
notifying the surgeon rather than allowing an uninformed signature, which would invalidate the consent and create a
legal liability. A brochure may supplement teaching but does not satisfy the legal disclosure requirement, and
delegating the explanation to family is neither ethical nor legally valid.
1
,NUR 265 Medical-Surgical Nursing | Final Examination 2026/2027 Galen College of Nursing
Q2: The nurse is reviewing the morning medication list for a client scheduled for abdominal surgery at
0800. Which medication order should the nurse clarify with the surgeon before the client goes to the
operating room?
A. Metoprolol 50 mg orally with a sip of water
B. Levothyroxine 100 mcg orally with a sip of water
C. Warfarin 5 mg orally on the morning of surgery [CORRECT]
D. Phenytoin 200 mg orally with a sip of water
Correct Answer: C
Rationale: Warfarin is an anticoagulant that significantly increases intraoperative and postoperative bleeding risk
and is normally discontinued about five days before surgery, sometimes with bridging therapy. Beta blockers,
levothyroxine, and antiseizure medications are typically continued on the day of surgery with a sip of water because
abruptly withholding them can cause rebound hypertension, dysrhythmias, thyroid storm, or seizures.
Q3: A preoperative client states, "The nurse told me to use that breathing gadget after surgery." Which
client statement indicates correct understanding of the purpose of incentive spirometry?
A. "It will help me breathe in medicated mist to open my airways."
B. "It will measure how much air I can blow out of my lungs."
C. "It will deliver oxygen while I sleep so I don't desaturate."
D. "It will help keep my small air sacs open so I don't get pneumonia." [CORRECT]
Correct Answer: D
Rationale: Incentive spirometry promotes sustained maximal inspiration, which inflates alveoli and prevents
alveolar collapse (atelectasis), the most common postoperative pulmonary complication caused by general
anesthesia, pain-limited breathing, and retained secretions. Nebulized mist, expiratory measurement, and
supplemental oxygen describe nebulizers, peak flow meters, and oxygen therapy, none of which prevent atelectasis.
Q4: A client arrives in the postanesthesia care unit (PACU) following an abdominal hysterectomy
performed under general anesthesia. Which assessment is the nurse's first priority?
A. Airway patency and respiratory rate, depth, and oxygen saturation [CORRECT]
B. Amount and character of drainage on the surgical dressing
C. Level of pain using the numeric rating scale
D. Hourly urinary output from the indwelling catheter
Correct Answer: A
Rationale: Prioritization follows the ABC framework: general anesthesia suppresses protective airway reflexes and
respiratory drive, so airway obstruction, laryngospasm, and hypoxemia are the earliest life-threatening postoperative
risks. Dressing drainage, pain, and urinary output are important assessments that follow once oxygenation and
ventilation are confirmed to be stable.
2
,NUR 265 Medical-Surgical Nursing | Final Examination 2026/2027 Galen College of Nursing
Q5: During an inguinal hernia repair under general anesthesia, the client develops tachycardia,
generalized muscle rigidity, and a rapidly rising end-tidal CO2; temperature is now 38.9 C (102 F).
Which intervention is the priority?
A. Apply a cooling blanket and continue close observation
B. Administer naloxone to reverse the anesthetic agents
C. Prepare and administer dantrolene sodium immediately [CORRECT]
D. Increase the concentration of the volatile anesthetic gas
Correct Answer: C
Rationale: These findings indicate malignant hyperthermia, a hypermetabolic crisis triggered by volatile anesthetic
agents and succinylcholine that causes uncontrolled skeletal muscle calcium release, rigidity, and extreme heat and
CO2 production. Dantrolene reverses the abnormal muscle metabolism and is the definitive treatment; cooling
measures are only adjunctive, naloxone does not reverse anesthetic triggers, and additional volatile agent would
worsen the crisis. Late temperature elevation means waiting for fever risks death.
Q6: A client who received spinal anesthesia reports a throbbing frontal headache that worsens when
sitting upright and improves when lying flat. Which nursing intervention is most appropriate?
A. Encourage increased oral fluids and maintain the client flat with the head slightly lowered
B. Seat the client upright at 90 degrees to decrease intracranial pressure [CORRECT]
C. Ambulate the client in the hallway to promote cerebral circulation
D. Restrict fluids to prevent cerebral edema and worsening headache
Correct Answer: B
Rationale: A post-dural puncture headache results from leakage of cerebrospinal fluid through the dural puncture
site, causing traction on pain-sensitive structures that is positional and relieved when supine. Hydration and flat
positioning promote CSF production and reduce the leak gradient, while an epidural blood patch may be performed
by the anesthesia provider if conservative measures fail. Upright positioning and ambulation worsen the leak, and
fluid restriction aggravates the deficit.
Q7: The nurse is planning care for a client on the first postoperative day following hip replacement
surgery. Which intervention is most effective in preventing venous thromboembolism?
A. Massaging the calves gently twice per shift to promote circulation
B. Placing pillows under the knees to elevate the extremities
C. Applying compression stockings only while the client is ambulating
D. Encouraging early, frequent ambulation with adequate hydration [CORRECT]
Correct Answer: D
Rationale: Early ambulation is the single most effective measure against venous thromboembolism because it
directly counteracts all components of Virchow's triad: venous stasis, endothelial injury, and hypercoagulability. Leg
massage can dislodge an existing thrombus into a pulmonary embolism, pillows under the knees compress popliteal
veins and impede return, and compression stockings should be worn throughout the immobile period rather than
only during ambulation.
3
, NUR 265 Medical-Surgical Nursing | Final Examination 2026/2027 Galen College of Nursing
Q8: Three days after an abdominal surgery, a client coughs forcefully and suddenly cries out that
"something gave way." The nurse observes protrusion of glistening, pinkish bowel through the incision.
Which action should the nurse take first?
A. Attempt to gently reinsert the protruding tissue into the abdomen
B. Cover the exposed bowel with sterile gauze moistened with sterile saline [CORRECT]
C. Instruct the client to splint the incision and cough deeply to expel secretions
D. Remove the remaining dressing to fully visualize the entire wound
Correct Answer: B
Rationale: Wound evisceration with exposed viscera is a surgical emergency; covering the bowel with sterile
saline-moistened gauze prevents desiccation and bacterial contamination while the client is placed in low Fowler
position with knees flexed and the surgeon is notified immediately. Repositioning bowel back into the abdomen
causes perforation and peritonitis, deep coughing worsens the dehiscence, and removing the dressing increases
contamination without benefit.
Q9: The surgical team is preparing to begin an elective laparoscopic appendectomy. Which action by the
circulating nurse best demonstrates adherence to the Universal Protocol surgical safety checklist?
A. Conducting a time-out to verify the correct client, procedure, and surgical site with all team members
[CORRECT]
B. Counting sponges and instruments only after the incision is closed
C. Confirming the client's insurance authorization before anesthesia induction
D. Marking the surgical site in the preoperative holding area alone without team verification
Correct Answer: A
Rationale: The Universal Protocol requires a time-out performed immediately before incision in which the entire
team actively verifies client identity, correct procedure, correct site, and imaging, with any team member
empowered to stop the procedure. Sponge counts are performed before, during, and after surgery rather than only at
closure, insurance verification is an administrative function unrelated to safety, and site marking alone does not
replace team verification.
Q10: A postoperative client has abdominal distention, absent bowel sounds in all quadrants, no passage of
flatus, and moderate nausea. Which prescription should the nurse anticipate implementing first?
A. Advance the diet to clear liquids to stimulate peristalsis
B. Administer a bisacodyl suppository to stimulate defecation
C. Keep the client NPO and insert a nasogastric tube to low intermittent suction [CORRECT]
D. Encourage the client to chew gum twice daily to activate the gastrocolic reflex
Correct Answer: C
Rationale: These findings indicate paralytic ileus, in which bowel motility is absent; the priorities are
decompression of the distended intestine via nasogastric suction, NPO status to rest the bowel, and intravenous
fluids to correct volume losses. Feeding an obstructed, nonfunctioning bowel, administering laxatives, or chewing
gum will not resolve distention and may precipitate vomiting and aspiration.
4
