NUR209 MEDICAL SURGICAL NURSING II BOARD REVIEW
2026/2027 | Verified Answers | NCLEX-RN Aligned | QSEN
Competencies | Pass Guaranteed - A+ Graded
Section 1: Perioperative & Critical Care Nursing (Questions 1-20)
Q1: A 68-year-old male is scheduled for an elective total hip arthroplasty. During the
preoperative assessment, the nurse notes he takes warfarin 5 mg daily for atrial
fibrillation. The surgeon's orders state to hold warfarin 5 days preoperatively and bridge
with enoxaparin. The nurse's priority action is to:
A. Verify the INR level and ensure it is below 1.5 before surgery
B. Administer the last dose of warfarin 24 hours before surgery
C. Begin enoxaparin bridging therapy immediately upon discontinuation of warfarin
D. Instruct the patient to continue warfarin until the morning of surgery
Correct Answer: A
Rationale: The nurse's priority is to verify the INR is therapeutic for surgery (typically
<1.5 for major procedures) before proceeding. While bridging with enoxaparin is
appropriate, the INR must be assessed first to determine baseline coagulation status.
Option B is incorrect because warfarin requires 5 days to clear; 24 hours is insufficient.
,Option C is incorrect because enoxaparin should not begin until warfarin effects have
diminished (typically 2 days after last dose). Option D is dangerous as continuing
warfarin increases bleeding risk intraoperatively. NCLEX Client Needs Category:
Physiological Integrity
Q2: A postoperative patient on mechanical ventilation has the following arterial blood
gas results: pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 26 mEq/L, PaO₂ 68 mmHg. The nurse
should anticipate which ventilator adjustment?
A. Increase the FiO₂ and decrease the tidal volume
B. Increase the respiratory rate and consider decreasing tidal volume
C. Increase the PEEP and decrease the respiratory rate
D. Decrease the tidal volume and increase the inspiratory time
Correct Answer: B
Rationale: These ABGs indicate acute respiratory acidosis (pH 7.30, elevated PaCO₂ 55,
normal HCO₃⁻) with hypoxemia. The primary problem is hypoventilation; increasing
respiratory rate improves CO₂ elimination. Decreasing tidal volume may be needed if the
patient is at risk for ventilator-induced lung injury. Option A would worsen CO₂ retention
by decreasing tidal volume without addressing rate. Option C would worsen CO₂
retention by decreasing rate. Option D does not address the primary respiratory
acidosis. NCLEX Client Needs Category: Physiological Integrity
,Q3: During the immediate postoperative period, a patient who underwent abdominal
surgery develops sudden-onset dyspnea, tachycardia (HR 118), and oxygen saturation
dropping to 88% on 2L nasal cannula. The nurse's first action is to:
A. Apply supplemental oxygen and prepare for possible intubation
B. Administer morphine 2 mg IV for pain-related tachypnea
C. Encourage deep breathing and coughing exercises
D. Obtain a STAT chest x-ray to confirm diagnosis
Correct Answer: A
Rationale: These findings are classic for pulmonary embolism, a life-threatening
postoperative complication. Applying oxygen is the immediate priority per the ABC
framework to address hypoxemia while preparing for advanced interventions. Option B
is contraindicated as morphine would depress respirations further. Option C is
inappropriate for a suspected PE and could worsen the embolus. Option D delays
life-saving oxygenation; imaging should not precede airway management. NCLEX Client
Needs Category: Safe and Effective Care Environment
Q4: (Select all that apply) A nurse is caring for a patient in the PACU following general
anesthesia. Which assessment findings require immediate intervention? Select all that
apply.
A. Shivering and body temperature of 35.8°C (96.4°F)
B. Respiratory rate of 8 breaths/minute with snoring respirations
C. Blood pressure 92/58 mmHg with warm, dry skin
D. Pain rating of 2/10 with stable vital signs
, E. Oxygen saturation 89% on 40% Venturi mask
Correct Answers: B, C, E
Rationale: B requires immediate intervention as respiratory rate of 8 with snoring
indicates airway obstruction/opioid-induced respiratory depression requiring naloxone
or airway support. C indicates hypovolemic shock (hypotension with warm, dry skin
suggests vasodilation and compensatory failure) requiring fluid resuscitation. E
indicates severe hypoxemia unresponsive to supplemental oxygen, suggesting shunt
physiology or acute lung injury. A is expected post-anesthesia hypothermia managed
with warming blankets. D is an acceptable pain level in the immediate postoperative
period. NCLEX Client Needs Category: Physiological Integrity
Q5: A patient is receiving propofol infusion for sedation while mechanically ventilated.
The nurse notes a sudden increase in triglycerides to 680 mg/dL and a new fever of
38.9°C. The nurse should:
A. Continue the propofol infusion and monitor liver function tests
B. Discontinue propofol immediately and notify the provider
C. Increase the propofol rate to achieve deeper sedation
D. Obtain blood cultures and start broad-spectrum antibiotics
Correct Answer: B
Rationale: Propofol infusion syndrome is characterized by metabolic acidosis,
hypertriglyceridemia, rhabdomyolysis, and cardiovascular collapse. Elevated
2026/2027 | Verified Answers | NCLEX-RN Aligned | QSEN
Competencies | Pass Guaranteed - A+ Graded
Section 1: Perioperative & Critical Care Nursing (Questions 1-20)
Q1: A 68-year-old male is scheduled for an elective total hip arthroplasty. During the
preoperative assessment, the nurse notes he takes warfarin 5 mg daily for atrial
fibrillation. The surgeon's orders state to hold warfarin 5 days preoperatively and bridge
with enoxaparin. The nurse's priority action is to:
A. Verify the INR level and ensure it is below 1.5 before surgery
B. Administer the last dose of warfarin 24 hours before surgery
C. Begin enoxaparin bridging therapy immediately upon discontinuation of warfarin
D. Instruct the patient to continue warfarin until the morning of surgery
Correct Answer: A
Rationale: The nurse's priority is to verify the INR is therapeutic for surgery (typically
<1.5 for major procedures) before proceeding. While bridging with enoxaparin is
appropriate, the INR must be assessed first to determine baseline coagulation status.
Option B is incorrect because warfarin requires 5 days to clear; 24 hours is insufficient.
,Option C is incorrect because enoxaparin should not begin until warfarin effects have
diminished (typically 2 days after last dose). Option D is dangerous as continuing
warfarin increases bleeding risk intraoperatively. NCLEX Client Needs Category:
Physiological Integrity
Q2: A postoperative patient on mechanical ventilation has the following arterial blood
gas results: pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 26 mEq/L, PaO₂ 68 mmHg. The nurse
should anticipate which ventilator adjustment?
A. Increase the FiO₂ and decrease the tidal volume
B. Increase the respiratory rate and consider decreasing tidal volume
C. Increase the PEEP and decrease the respiratory rate
D. Decrease the tidal volume and increase the inspiratory time
Correct Answer: B
Rationale: These ABGs indicate acute respiratory acidosis (pH 7.30, elevated PaCO₂ 55,
normal HCO₃⁻) with hypoxemia. The primary problem is hypoventilation; increasing
respiratory rate improves CO₂ elimination. Decreasing tidal volume may be needed if the
patient is at risk for ventilator-induced lung injury. Option A would worsen CO₂ retention
by decreasing tidal volume without addressing rate. Option C would worsen CO₂
retention by decreasing rate. Option D does not address the primary respiratory
acidosis. NCLEX Client Needs Category: Physiological Integrity
,Q3: During the immediate postoperative period, a patient who underwent abdominal
surgery develops sudden-onset dyspnea, tachycardia (HR 118), and oxygen saturation
dropping to 88% on 2L nasal cannula. The nurse's first action is to:
A. Apply supplemental oxygen and prepare for possible intubation
B. Administer morphine 2 mg IV for pain-related tachypnea
C. Encourage deep breathing and coughing exercises
D. Obtain a STAT chest x-ray to confirm diagnosis
Correct Answer: A
Rationale: These findings are classic for pulmonary embolism, a life-threatening
postoperative complication. Applying oxygen is the immediate priority per the ABC
framework to address hypoxemia while preparing for advanced interventions. Option B
is contraindicated as morphine would depress respirations further. Option C is
inappropriate for a suspected PE and could worsen the embolus. Option D delays
life-saving oxygenation; imaging should not precede airway management. NCLEX Client
Needs Category: Safe and Effective Care Environment
Q4: (Select all that apply) A nurse is caring for a patient in the PACU following general
anesthesia. Which assessment findings require immediate intervention? Select all that
apply.
A. Shivering and body temperature of 35.8°C (96.4°F)
B. Respiratory rate of 8 breaths/minute with snoring respirations
C. Blood pressure 92/58 mmHg with warm, dry skin
D. Pain rating of 2/10 with stable vital signs
, E. Oxygen saturation 89% on 40% Venturi mask
Correct Answers: B, C, E
Rationale: B requires immediate intervention as respiratory rate of 8 with snoring
indicates airway obstruction/opioid-induced respiratory depression requiring naloxone
or airway support. C indicates hypovolemic shock (hypotension with warm, dry skin
suggests vasodilation and compensatory failure) requiring fluid resuscitation. E
indicates severe hypoxemia unresponsive to supplemental oxygen, suggesting shunt
physiology or acute lung injury. A is expected post-anesthesia hypothermia managed
with warming blankets. D is an acceptable pain level in the immediate postoperative
period. NCLEX Client Needs Category: Physiological Integrity
Q5: A patient is receiving propofol infusion for sedation while mechanically ventilated.
The nurse notes a sudden increase in triglycerides to 680 mg/dL and a new fever of
38.9°C. The nurse should:
A. Continue the propofol infusion and monitor liver function tests
B. Discontinue propofol immediately and notify the provider
C. Increase the propofol rate to achieve deeper sedation
D. Obtain blood cultures and start broad-spectrum antibiotics
Correct Answer: B
Rationale: Propofol infusion syndrome is characterized by metabolic acidosis,
hypertriglyceridemia, rhabdomyolysis, and cardiovascular collapse. Elevated
