NUR 242 Exams 1–4 () | Med-
Surg Nursing | Galen College | PDF
Exam 1: Perioperative & Foundational Concepts
1. A client scheduled for surgery cannot read or write. The surgeon wants the
client's spouse to sign the consent instead. What is the best action?
A) Have the spouse sign since the client cannot read
B) Inform the surgeon the client may sign with an "X" in front of two witnesses
C) Notify administration to seek a court-appointed guardian
D) Proceed without a signed consent
Correct answer is B. Inability to read or write does not indicate incapacity to provide legal
consent. The client can sign with an "X" witnessed by two people, provided they
understand the procedure.
2. What is the correct timeframe for "Emergent" surgery?
A) Without delay
B) Within 24–30 hours
C) Personal preference
D) Within 6 weeks
Correct answer is A. Emergent surgery must be performed immediately to preserve life or
prevent permanent disability. Think "EMERGENT" = EMERGENCY.
3. What is the correct definition for "Elective" surgery?
A) Without delay
B) Within 24–30 hours
C) Personal preference
D) Failure to have surgery is not catastrophic
Correct answer is D. Elective surgery is scheduled at the patient's convenience and does
not pose an immediate threat to life if delayed.
, 4. Which technique is best when rinsing hands and forearms after a surgical scrub?
A) Starting at the hand with water running up the forearm
B) Starting with the hand positioned so water runs off the extremity
C) Starting at the elbow with water running down to the hand
D) Rinsing is not performed
Correct answer is B. Rinsing should allow water to run off the hand rather than up or
down the extremity to prevent contaminants from moving onto scrubbed surfaces.
5. Which client is at greatest risk for respiratory complications after general
anesthesia?
A) 55-year-old with chronic allergic rhinitis
B) 65-year-old on calcium channel blockers
C) 45-year-old with type 1 diabetes
D) 68-year-old with COPD who smokes
Correct answer is D. Advanced age, smoking history, and pre-existing respiratory disease
(COPD) significantly increase the risk of postoperative pulmonary complications.
Exam 2: Fluid & Electrolyte Balance
6. A patient with heart failure gains 2 kg (4.4 lbs) in 24 hours. What is the priority
action?
A) Restrict fluid intake to 1 L/day
B) Administer furosemide as prescribed
C) Assess lung sounds and oxygen saturation
D) Elevate the head of the bed
Correct answer is C. Rapid weight gain indicates fluid retention. The nurse must first assess
respiratory status (lung sounds, SpO₂) to detect pulmonary edema before implementing
other interventions.
7. A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which
ECG change is expected?
A) U waves
, B) Peaked T waves
C) ST segment depression
D) Prolonged PR interval
Correct answer is B. Hyperkalemia (K⁺ >5.5 mEq/L) causes tall, peaked T waves. U waves
are seen in hypokalemia.
8. What are signs and symptoms of dehydration?
A) Bounding pulse, weight gain, crackles
B) Thready pulse, hypotension, dry mucous membranes, oliguria
C) Hypertension, JVD, edema
D) Bradycardia, warm skin, polyuria
Correct answer is B. Dehydration causes hypovolemia with thready pulse, hypotension, dry
tongue, and decreased urine output (oliguria).
9. A patient with hypocalcemia would exhibit which signs?
A) Muscle weakness, constipation, kidney stones
B) Tetany, Chvostek sign, Trousseau sign
C) Hypertension, bounding pulses
D) Polyuria, bone pain
Correct answer is B. Hypocalcemia causes neuromuscular irritability leading to tetany,
Chvostek sign (facial twitching), and Trousseau sign (carpal spasm).
10. A patient with hyperkalemia should avoid which foods?
A) Milk, cheese, yogurt
B) Bananas, oranges, potatoes, avocados
C) Apples, grapes, rice
D) Bread, pasta, eggs
Correct answer is B. Potassium-rich foods such as bananas, oranges, potatoes, and
avocados should be avoided in hyperkalemia.
11. A patient with hypokalemia has which ECG change?
A) Peaked T waves
B) Prolonged PR interval
C) Flattened T waves, ST depression, and U waves
D) Wide QRS complex
, Correct answer is C. Hypokalemia causes flattened T waves, ST depression, and prominent
U waves. This increases the risk of cardiac arrhythmias.
Exam 3: Cardiovascular & Respiratory Disorders
12. A patient with heart failure has crackles, tachypnea, and SpO₂ 88%. What is the
priority nursing intervention?
A) Administer digoxin
B) Place the client in a high-Fowler position
C) Notify the provider immediately
D) Apply oxygen at 2 L/min
Correct answer is B. High-Fowler position uses gravity to reduce venous return (preload)
and promote lung expansion. This is the immediate priority to improve breathing.
13. A patient with right-sided heart failure would exhibit which findings? (Select
all that apply)
A) Dependent edema
B) Crackles in lung bases
C) Swollen hands and fingers
D) Right upper quadrant discomfort (hepatomegaly)
E) Paroxysmal nocturnal dyspnea
Correct answers are A, C, D. Right-sided heart failure causes systemic congestion:
dependent edema, swollen extremities, and hepatomegaly (RUQ discomfort). Crackles and
PND indicate left-sided failure.
14. A patient takes furosemide and digoxin for heart failure. Why advise orange
juice daily?
A) To enhance digoxin absorption
B) To maintain potassium levels
C) To prevent constipation
D) To promote diuresis
Correct answer is B. Furosemide is a potassium-wasting diuretic. Hypokalemia increases
the risk of digoxin toxicity. Orange juice is a good potassium source.
Surg Nursing | Galen College | PDF
Exam 1: Perioperative & Foundational Concepts
1. A client scheduled for surgery cannot read or write. The surgeon wants the
client's spouse to sign the consent instead. What is the best action?
A) Have the spouse sign since the client cannot read
B) Inform the surgeon the client may sign with an "X" in front of two witnesses
C) Notify administration to seek a court-appointed guardian
D) Proceed without a signed consent
Correct answer is B. Inability to read or write does not indicate incapacity to provide legal
consent. The client can sign with an "X" witnessed by two people, provided they
understand the procedure.
2. What is the correct timeframe for "Emergent" surgery?
A) Without delay
B) Within 24–30 hours
C) Personal preference
D) Within 6 weeks
Correct answer is A. Emergent surgery must be performed immediately to preserve life or
prevent permanent disability. Think "EMERGENT" = EMERGENCY.
3. What is the correct definition for "Elective" surgery?
A) Without delay
B) Within 24–30 hours
C) Personal preference
D) Failure to have surgery is not catastrophic
Correct answer is D. Elective surgery is scheduled at the patient's convenience and does
not pose an immediate threat to life if delayed.
, 4. Which technique is best when rinsing hands and forearms after a surgical scrub?
A) Starting at the hand with water running up the forearm
B) Starting with the hand positioned so water runs off the extremity
C) Starting at the elbow with water running down to the hand
D) Rinsing is not performed
Correct answer is B. Rinsing should allow water to run off the hand rather than up or
down the extremity to prevent contaminants from moving onto scrubbed surfaces.
5. Which client is at greatest risk for respiratory complications after general
anesthesia?
A) 55-year-old with chronic allergic rhinitis
B) 65-year-old on calcium channel blockers
C) 45-year-old with type 1 diabetes
D) 68-year-old with COPD who smokes
Correct answer is D. Advanced age, smoking history, and pre-existing respiratory disease
(COPD) significantly increase the risk of postoperative pulmonary complications.
Exam 2: Fluid & Electrolyte Balance
6. A patient with heart failure gains 2 kg (4.4 lbs) in 24 hours. What is the priority
action?
A) Restrict fluid intake to 1 L/day
B) Administer furosemide as prescribed
C) Assess lung sounds and oxygen saturation
D) Elevate the head of the bed
Correct answer is C. Rapid weight gain indicates fluid retention. The nurse must first assess
respiratory status (lung sounds, SpO₂) to detect pulmonary edema before implementing
other interventions.
7. A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which
ECG change is expected?
A) U waves
, B) Peaked T waves
C) ST segment depression
D) Prolonged PR interval
Correct answer is B. Hyperkalemia (K⁺ >5.5 mEq/L) causes tall, peaked T waves. U waves
are seen in hypokalemia.
8. What are signs and symptoms of dehydration?
A) Bounding pulse, weight gain, crackles
B) Thready pulse, hypotension, dry mucous membranes, oliguria
C) Hypertension, JVD, edema
D) Bradycardia, warm skin, polyuria
Correct answer is B. Dehydration causes hypovolemia with thready pulse, hypotension, dry
tongue, and decreased urine output (oliguria).
9. A patient with hypocalcemia would exhibit which signs?
A) Muscle weakness, constipation, kidney stones
B) Tetany, Chvostek sign, Trousseau sign
C) Hypertension, bounding pulses
D) Polyuria, bone pain
Correct answer is B. Hypocalcemia causes neuromuscular irritability leading to tetany,
Chvostek sign (facial twitching), and Trousseau sign (carpal spasm).
10. A patient with hyperkalemia should avoid which foods?
A) Milk, cheese, yogurt
B) Bananas, oranges, potatoes, avocados
C) Apples, grapes, rice
D) Bread, pasta, eggs
Correct answer is B. Potassium-rich foods such as bananas, oranges, potatoes, and
avocados should be avoided in hyperkalemia.
11. A patient with hypokalemia has which ECG change?
A) Peaked T waves
B) Prolonged PR interval
C) Flattened T waves, ST depression, and U waves
D) Wide QRS complex
, Correct answer is C. Hypokalemia causes flattened T waves, ST depression, and prominent
U waves. This increases the risk of cardiac arrhythmias.
Exam 3: Cardiovascular & Respiratory Disorders
12. A patient with heart failure has crackles, tachypnea, and SpO₂ 88%. What is the
priority nursing intervention?
A) Administer digoxin
B) Place the client in a high-Fowler position
C) Notify the provider immediately
D) Apply oxygen at 2 L/min
Correct answer is B. High-Fowler position uses gravity to reduce venous return (preload)
and promote lung expansion. This is the immediate priority to improve breathing.
13. A patient with right-sided heart failure would exhibit which findings? (Select
all that apply)
A) Dependent edema
B) Crackles in lung bases
C) Swollen hands and fingers
D) Right upper quadrant discomfort (hepatomegaly)
E) Paroxysmal nocturnal dyspnea
Correct answers are A, C, D. Right-sided heart failure causes systemic congestion:
dependent edema, swollen extremities, and hepatomegaly (RUQ discomfort). Crackles and
PND indicate left-sided failure.
14. A patient takes furosemide and digoxin for heart failure. Why advise orange
juice daily?
A) To enhance digoxin absorption
B) To maintain potassium levels
C) To prevent constipation
D) To promote diuresis
Correct answer is B. Furosemide is a potassium-wasting diuretic. Hypokalemia increases
the risk of digoxin toxicity. Orange juice is a good potassium source.
