NR 324 ADULT HEALTH I
Final Exam Study Guide
Chamberlain University
Course Code: NR 324
Course Name: Adult Health I
180 Questions with Correct Answers and Rationales
Section 1: Perioperative Care, Pain, Fluid/Electrolyte and Acid-Base Balance,
Shock, Wound Healing and Infection
1. What are the three phases of perioperative nursing care?
Correct Answer: Preoperative, intraoperative, and postoperative.
Rationale: Each phase has distinct nursing responsibilities from decision for surgery through
recovery.
2. Who is responsible for obtaining informed consent for surgery?
Correct Answer: The surgeon or provider performing the procedure; the nurse witnesses the
client's signature.
Rationale: The provider must explain risks, benefits, and alternatives. The nurse verifies
understanding and that the client signs voluntarily.
3. A client scheduled for surgery says, "I'm not sure I want this." What is the nurse's
priority?
Correct Answer: Notify the surgeon and hold the consent process until the client's questions
are addressed.
Rationale: Consent must be voluntary and informed. The nurse acts as client advocate.
4. How long should a client typically be NPO before surgery with general anesthesia?
Correct Answer: Solids at least 6 to 8 hours and clear liquids up to 2 hours before, per
facility policy.
Rationale: An empty stomach lowers the risk of aspiration during anesthesia.
NR 324 Adult Health I Final Exam Study Guide | Page 1
,5. Which preoperative medication finding should be reported to the surgeon?
Correct Answer: Use of anticoagulants, aspirin, herbal supplements such as ginkgo or
garlic, or MAOIs.
Rationale: These can increase bleeding or interact with anesthesia.
6. What is the major risk of malignant hyperthermia and which drug treats it?
Correct Answer: Rapidly rising temperature, muscle rigidity, and tachycardia triggered by
anesthetics; dantrolene sodium.
Rationale: Dantrolene blocks calcium release from muscle stores. Cooling and 100% oxygen
are also given.
7. What is the nurse's priority in the immediate postoperative period (PACU)?
Correct Answer: Maintain a patent airway and assess breathing and circulation.
Rationale: Airway obstruction from the tongue or secretions is the most common early
complication.
8. A postoperative client has a pulse of 120, BP of 88/50, and cool, clammy skin. What does
the nurse suspect?
Correct Answer: Hemorrhage or hypovolemic shock.
Rationale: Tachycardia and hypotension are early signs of fluid or blood loss. Check the
dressing and notify the provider.
9. Which postoperative interventions prevent atelectasis?
Correct Answer: Deep breathing, coughing, incentive spirometry, and early ambulation.
Rationale: These measures expand alveoli and mobilize secretions.
10. When should the nurse expect a postoperative client to have a first void?
Correct Answer: Within 6 to 8 hours after surgery.
Rationale: Inability to void with a distended bladder suggests urinary retention.
11. What is the nursing action for suspected wound dehiscence?
Correct Answer: Cover the wound with sterile saline-moistened gauze, place the client in
low Fowler's with knees bent, and notify the surgeon.
Rationale: Evisceration is a surgical emergency. Do not push organs back in.
12. What are the signs of surgical site infection?
Correct Answer: Redness, warmth, swelling, purulent drainage, increasing pain, and fever,
usually 3 to 5 days after surgery.
Rationale: Early recognition permits treatment before sepsis develops.
13. How is a Jackson-Pratt drain emptied and maintained?
Correct Answer: Empty the reservoir, compress to create suction, and record the drainage
amount and color.
Rationale: Suction promotes drainage and healing of the surgical site.
NR 324 Adult Health I Final Exam Study Guide | Page 2
, 14. Which factors delay wound healing?
Correct Answer: Poor nutrition, infection, diabetes, smoking, advanced age, corticosteroids,
and poor perfusion.
Rationale: These factors impair collagen formation, circulation, or immune response.
15. Which nutrients promote wound healing?
Correct Answer: Protein, vitamin C, vitamin A, zinc, and adequate calories.
Rationale: Protein and vitamin C are required for collagen synthesis.
16. What are the phases of wound healing?
Correct Answer: Hemostasis, inflammation, proliferation, and maturation (remodeling).
Rationale: Each phase has a role from clot formation to scar strengthening.
17. What is the difference between healing by primary, secondary, and tertiary intention?
Correct Answer: Primary: edges approximated (sutured). Secondary: open wound heals
from base by granulation. Tertiary: delayed closure after infection resolves.
Rationale: The type of closure affects healing time and scarring.
18. How should the nurse assess pain in a client who is postoperative?
Correct Answer: Ask for location, quality, intensity (0 to 10), and aggravating and relieving
factors, and reassess after interventions.
Rationale: The client's self-report is the most reliable indicator of pain.
19. What is the advantage of patient-controlled analgesia (PCA)?
Correct Answer: The client self-administers small opioid doses, maintaining steadier pain
control.
Rationale: Only the client should press the button to avoid overdose (no PCA by proxy).
20. Which opioid adverse effect should the nurse monitor first?
Correct Answer: Respiratory depression and sedation.
Rationale: Use a sedation scale (POSS) and hold the dose if the respiratory rate is less than
10 to 12.
21. Which medication is the first-line choice for mild pain?
Correct Answer: Acetaminophen or an NSAID.
Rationale: The WHO analgesic ladder starts with non-opioids for mild pain.
22. What is the maximum daily dose of acetaminophen for most adults, and what organ is
at risk?
Correct Answer: 4 grams per day (often 3 grams limit advised); the liver.
Rationale: Overdose causes hepatotoxicity. The antidote is acetylcysteine.
NR 324 Adult Health I Final Exam Study Guide | Page 3
Final Exam Study Guide
Chamberlain University
Course Code: NR 324
Course Name: Adult Health I
180 Questions with Correct Answers and Rationales
Section 1: Perioperative Care, Pain, Fluid/Electrolyte and Acid-Base Balance,
Shock, Wound Healing and Infection
1. What are the three phases of perioperative nursing care?
Correct Answer: Preoperative, intraoperative, and postoperative.
Rationale: Each phase has distinct nursing responsibilities from decision for surgery through
recovery.
2. Who is responsible for obtaining informed consent for surgery?
Correct Answer: The surgeon or provider performing the procedure; the nurse witnesses the
client's signature.
Rationale: The provider must explain risks, benefits, and alternatives. The nurse verifies
understanding and that the client signs voluntarily.
3. A client scheduled for surgery says, "I'm not sure I want this." What is the nurse's
priority?
Correct Answer: Notify the surgeon and hold the consent process until the client's questions
are addressed.
Rationale: Consent must be voluntary and informed. The nurse acts as client advocate.
4. How long should a client typically be NPO before surgery with general anesthesia?
Correct Answer: Solids at least 6 to 8 hours and clear liquids up to 2 hours before, per
facility policy.
Rationale: An empty stomach lowers the risk of aspiration during anesthesia.
NR 324 Adult Health I Final Exam Study Guide | Page 1
,5. Which preoperative medication finding should be reported to the surgeon?
Correct Answer: Use of anticoagulants, aspirin, herbal supplements such as ginkgo or
garlic, or MAOIs.
Rationale: These can increase bleeding or interact with anesthesia.
6. What is the major risk of malignant hyperthermia and which drug treats it?
Correct Answer: Rapidly rising temperature, muscle rigidity, and tachycardia triggered by
anesthetics; dantrolene sodium.
Rationale: Dantrolene blocks calcium release from muscle stores. Cooling and 100% oxygen
are also given.
7. What is the nurse's priority in the immediate postoperative period (PACU)?
Correct Answer: Maintain a patent airway and assess breathing and circulation.
Rationale: Airway obstruction from the tongue or secretions is the most common early
complication.
8. A postoperative client has a pulse of 120, BP of 88/50, and cool, clammy skin. What does
the nurse suspect?
Correct Answer: Hemorrhage or hypovolemic shock.
Rationale: Tachycardia and hypotension are early signs of fluid or blood loss. Check the
dressing and notify the provider.
9. Which postoperative interventions prevent atelectasis?
Correct Answer: Deep breathing, coughing, incentive spirometry, and early ambulation.
Rationale: These measures expand alveoli and mobilize secretions.
10. When should the nurse expect a postoperative client to have a first void?
Correct Answer: Within 6 to 8 hours after surgery.
Rationale: Inability to void with a distended bladder suggests urinary retention.
11. What is the nursing action for suspected wound dehiscence?
Correct Answer: Cover the wound with sterile saline-moistened gauze, place the client in
low Fowler's with knees bent, and notify the surgeon.
Rationale: Evisceration is a surgical emergency. Do not push organs back in.
12. What are the signs of surgical site infection?
Correct Answer: Redness, warmth, swelling, purulent drainage, increasing pain, and fever,
usually 3 to 5 days after surgery.
Rationale: Early recognition permits treatment before sepsis develops.
13. How is a Jackson-Pratt drain emptied and maintained?
Correct Answer: Empty the reservoir, compress to create suction, and record the drainage
amount and color.
Rationale: Suction promotes drainage and healing of the surgical site.
NR 324 Adult Health I Final Exam Study Guide | Page 2
, 14. Which factors delay wound healing?
Correct Answer: Poor nutrition, infection, diabetes, smoking, advanced age, corticosteroids,
and poor perfusion.
Rationale: These factors impair collagen formation, circulation, or immune response.
15. Which nutrients promote wound healing?
Correct Answer: Protein, vitamin C, vitamin A, zinc, and adequate calories.
Rationale: Protein and vitamin C are required for collagen synthesis.
16. What are the phases of wound healing?
Correct Answer: Hemostasis, inflammation, proliferation, and maturation (remodeling).
Rationale: Each phase has a role from clot formation to scar strengthening.
17. What is the difference between healing by primary, secondary, and tertiary intention?
Correct Answer: Primary: edges approximated (sutured). Secondary: open wound heals
from base by granulation. Tertiary: delayed closure after infection resolves.
Rationale: The type of closure affects healing time and scarring.
18. How should the nurse assess pain in a client who is postoperative?
Correct Answer: Ask for location, quality, intensity (0 to 10), and aggravating and relieving
factors, and reassess after interventions.
Rationale: The client's self-report is the most reliable indicator of pain.
19. What is the advantage of patient-controlled analgesia (PCA)?
Correct Answer: The client self-administers small opioid doses, maintaining steadier pain
control.
Rationale: Only the client should press the button to avoid overdose (no PCA by proxy).
20. Which opioid adverse effect should the nurse monitor first?
Correct Answer: Respiratory depression and sedation.
Rationale: Use a sedation scale (POSS) and hold the dose if the respiratory rate is less than
10 to 12.
21. Which medication is the first-line choice for mild pain?
Correct Answer: Acetaminophen or an NSAID.
Rationale: The WHO analgesic ladder starts with non-opioids for mild pain.
22. What is the maximum daily dose of acetaminophen for most adults, and what organ is
at risk?
Correct Answer: 4 grams per day (often 3 grams limit advised); the liver.
Rationale: Overdose causes hepatotoxicity. The antidote is acetylcysteine.
NR 324 Adult Health I Final Exam Study Guide | Page 3
