NU 136 Fundamentals of Nursing
ACTUAL EXAM 2026/2027 | Exam 4
Review Paper | Fundamentals of Nursing
| Verified Q&A | Pass Guaranteed - A+
Graded
SECTION 1: PERIOPERATIVE NURSING (20 Questions)
Q1: A patient is scheduled for elective surgery in 3 days. Which preoperative instruction is
most important for the nurse to provide regarding NPO status?
A. "You may have clear liquids up to 2 hours before surgery"
B. "You should fast from all food and drink beginning at midnight before surgery" [CORRECT]
C. "You may drink water up to 30 minutes before anesthesia"
D. "A light breakfast is permitted the morning of surgery"
Correct Answer: B
Rationale: The standard NPO guideline for elective surgery is nothing by mouth after midnight
(or 8 hours for a full meal) to reduce aspiration risk. While some facilities use liberalized
clear liquid protocols (2-4 hours), the conservative "midnight" rule remains the safest
standard teaching for nursing fundamentals. Aspiration during anesthesia can cause
chemical pneumonitis and respiratory failure.
NU 136 Note: Exam Critical: Always verify surgeon-specific orders; when in doubt, maintain
NPO status and contact provider.
Q2: During preoperative assessment, a patient reports taking warfarin (Coumadin) 5mg daily.
What is the nurse's priority action?
A. Document the medication and continue with routine preoperative teaching
B. Notify the surgeon immediately about the anticoagulant use [CORRECT]
,C. Instruct the patient to take the dose the morning of surgery
D. Advise the patient to stop the medication independently
Correct Answer: B
Rationale: Warfarin increases bleeding risk during surgery and typically requires
discontinuation 5 days preoperatively with possible bridging therapy. The surgeon and
anesthesia provider must make this determination—not the nurse or patient independently.
This requires immediate communication to prevent hemorrhagic complications.
Q3: A patient refuses to sign the informed consent form, stating "I don't understand what the
doctor explained." What is the appropriate nursing action?
A. Witness the signature and document the refusal
B. Explain the procedure in detail and have the patient sign
C. Notify the surgeon that the patient needs further explanation [CORRECT]
D. Proceed with preoperative preparation while waiting for consent
Correct Answer: C
Rationale: Informed consent is a physician responsibility; nurses witness signature, verify
understanding, and ensure voluntariness. If the patient lacks understanding, the surgeon must
provide additional explanation. Nurses cannot obtain informed consent or coerce signing.
This protects patient autonomy and prevents legal liability.
Q4: Which positioning technique is appropriate for a patient undergoing spinal anesthesia for
lower extremity surgery?
A. Trendelenburg position
B. Supine with legs elevated
C. Lateral decubitus or sitting "fetal" position for injection, then supine [CORRECT]
D. Prone position with neck flexion
Correct Answer: C
Rationale: Spinal anesthesia requires patient positioning that opens the intervertebral spaces
for needle insertion—typically lateral decubitus with knees-to-chest or sitting with back
,flexed. After injection, supine positioning allows anesthetic distribution and level
assessment. Trendelenburg is used for hypotension management post-spinal, not during
injection.
Q5: In the PACU, a postoperative patient develops stridor, inspiratory wheezing, and use of
accessory muscles. What is the priority nursing intervention?
A. Administer supplemental oxygen via nasal cannula
B. Prepare for possible reintubation and call for immediate provider assistance [CORRECT]
C. Position patient in high Fowler's and encourage coughing
D. Document findings and continue routine monitoring
Correct Answer: B
Rationale: These findings indicate laryngeal edema or upper airway obstruction—potentially
life-threatening complications of extubation. While oxygen and positioning help, this is an
emergency requiring immediate provider notification for possible reintubation, racemic
epinephrine, or corticosteroids. Delay can result in complete airway obstruction and
respiratory arrest.
Q6: A postoperative patient on PCA morphine has respiratory rate of 8/min, SpO2 88%, and is
difficult to arouse. What is the nurse's first action?
A. Continue monitoring and document findings
B. Administer the prescribed PRN naloxone (Narcan) [CORRECT]
C. Increase the PCA basal rate to improve pain control
D. Apply supplemental oxygen and reassess in 15 minutes
Correct Answer: B
Rationale: These are classic signs of opioid-induced respiratory depression. Naloxone is the
antidote for opioid overdose and respiratory depression. While oxygen supports SpO2, it does
not address the central respiratory drive suppression. This is a medical emergency requiring
immediate reversal agent administration per protocol.
Q7: During the first 24 hours postoperatively, which assessment finding indicates normal
inflammatory phase of wound healing?
, A. Wound edges well-approximated with serosanguineous drainage
B. Frank purulent drainage with foul odor
C. Erythema, warmth, and mild edema at incision site [CORRECT]
D. Wound dehiscence with visible fascia
Correct Answer: C
Rationale: The inflammatory phase (days 1-4) involves erythema, warmth, edema, and mild
pain due to histamine release and increased vascular permeability. This normal response
facilitates healing. Purulent drainage, foul odor, or dehiscence indicate infection or wound
failure, not normal healing.
Q8: A patient is 2 days postoperative from abdominal surgery and reports "something gave
way" in their incision. Assessment reveals wound separation with visible pink tissue. This is:
A. Wound evisceration requiring immediate surgical intervention
B. Wound dehiscence involving partial or total separation of wound layers [CORRECT]
C. Normal wound healing during proliferative phase
D. Surgical site infection requiring antibiotic therapy
Correct Answer: B
Rationale: Dehiscence is partial or complete separation of wound layers without protrusion
of organs (visible pink tissue indicates granulation, not viscera). Evisceration involves organ
protrusion and is a surgical emergency. This patient has dehiscence requiring sterile
dressing, NPO status, and surgical consultation—not immediate organ coverage unless
evisceration occurs.
Q9: Which patient is at highest risk for postoperative venous thromboembolism (VTE)?
A. 25-year-old undergoing laparoscopic appendectomy
B. 45-year-old having same-day arthroscopy
C. 68-year-old having total hip replacement with history of DVT [CORRECT]
D. 35-year-old scheduled for thyroidectomy
ACTUAL EXAM 2026/2027 | Exam 4
Review Paper | Fundamentals of Nursing
| Verified Q&A | Pass Guaranteed - A+
Graded
SECTION 1: PERIOPERATIVE NURSING (20 Questions)
Q1: A patient is scheduled for elective surgery in 3 days. Which preoperative instruction is
most important for the nurse to provide regarding NPO status?
A. "You may have clear liquids up to 2 hours before surgery"
B. "You should fast from all food and drink beginning at midnight before surgery" [CORRECT]
C. "You may drink water up to 30 minutes before anesthesia"
D. "A light breakfast is permitted the morning of surgery"
Correct Answer: B
Rationale: The standard NPO guideline for elective surgery is nothing by mouth after midnight
(or 8 hours for a full meal) to reduce aspiration risk. While some facilities use liberalized
clear liquid protocols (2-4 hours), the conservative "midnight" rule remains the safest
standard teaching for nursing fundamentals. Aspiration during anesthesia can cause
chemical pneumonitis and respiratory failure.
NU 136 Note: Exam Critical: Always verify surgeon-specific orders; when in doubt, maintain
NPO status and contact provider.
Q2: During preoperative assessment, a patient reports taking warfarin (Coumadin) 5mg daily.
What is the nurse's priority action?
A. Document the medication and continue with routine preoperative teaching
B. Notify the surgeon immediately about the anticoagulant use [CORRECT]
,C. Instruct the patient to take the dose the morning of surgery
D. Advise the patient to stop the medication independently
Correct Answer: B
Rationale: Warfarin increases bleeding risk during surgery and typically requires
discontinuation 5 days preoperatively with possible bridging therapy. The surgeon and
anesthesia provider must make this determination—not the nurse or patient independently.
This requires immediate communication to prevent hemorrhagic complications.
Q3: A patient refuses to sign the informed consent form, stating "I don't understand what the
doctor explained." What is the appropriate nursing action?
A. Witness the signature and document the refusal
B. Explain the procedure in detail and have the patient sign
C. Notify the surgeon that the patient needs further explanation [CORRECT]
D. Proceed with preoperative preparation while waiting for consent
Correct Answer: C
Rationale: Informed consent is a physician responsibility; nurses witness signature, verify
understanding, and ensure voluntariness. If the patient lacks understanding, the surgeon must
provide additional explanation. Nurses cannot obtain informed consent or coerce signing.
This protects patient autonomy and prevents legal liability.
Q4: Which positioning technique is appropriate for a patient undergoing spinal anesthesia for
lower extremity surgery?
A. Trendelenburg position
B. Supine with legs elevated
C. Lateral decubitus or sitting "fetal" position for injection, then supine [CORRECT]
D. Prone position with neck flexion
Correct Answer: C
Rationale: Spinal anesthesia requires patient positioning that opens the intervertebral spaces
for needle insertion—typically lateral decubitus with knees-to-chest or sitting with back
,flexed. After injection, supine positioning allows anesthetic distribution and level
assessment. Trendelenburg is used for hypotension management post-spinal, not during
injection.
Q5: In the PACU, a postoperative patient develops stridor, inspiratory wheezing, and use of
accessory muscles. What is the priority nursing intervention?
A. Administer supplemental oxygen via nasal cannula
B. Prepare for possible reintubation and call for immediate provider assistance [CORRECT]
C. Position patient in high Fowler's and encourage coughing
D. Document findings and continue routine monitoring
Correct Answer: B
Rationale: These findings indicate laryngeal edema or upper airway obstruction—potentially
life-threatening complications of extubation. While oxygen and positioning help, this is an
emergency requiring immediate provider notification for possible reintubation, racemic
epinephrine, or corticosteroids. Delay can result in complete airway obstruction and
respiratory arrest.
Q6: A postoperative patient on PCA morphine has respiratory rate of 8/min, SpO2 88%, and is
difficult to arouse. What is the nurse's first action?
A. Continue monitoring and document findings
B. Administer the prescribed PRN naloxone (Narcan) [CORRECT]
C. Increase the PCA basal rate to improve pain control
D. Apply supplemental oxygen and reassess in 15 minutes
Correct Answer: B
Rationale: These are classic signs of opioid-induced respiratory depression. Naloxone is the
antidote for opioid overdose and respiratory depression. While oxygen supports SpO2, it does
not address the central respiratory drive suppression. This is a medical emergency requiring
immediate reversal agent administration per protocol.
Q7: During the first 24 hours postoperatively, which assessment finding indicates normal
inflammatory phase of wound healing?
, A. Wound edges well-approximated with serosanguineous drainage
B. Frank purulent drainage with foul odor
C. Erythema, warmth, and mild edema at incision site [CORRECT]
D. Wound dehiscence with visible fascia
Correct Answer: C
Rationale: The inflammatory phase (days 1-4) involves erythema, warmth, edema, and mild
pain due to histamine release and increased vascular permeability. This normal response
facilitates healing. Purulent drainage, foul odor, or dehiscence indicate infection or wound
failure, not normal healing.
Q8: A patient is 2 days postoperative from abdominal surgery and reports "something gave
way" in their incision. Assessment reveals wound separation with visible pink tissue. This is:
A. Wound evisceration requiring immediate surgical intervention
B. Wound dehiscence involving partial or total separation of wound layers [CORRECT]
C. Normal wound healing during proliferative phase
D. Surgical site infection requiring antibiotic therapy
Correct Answer: B
Rationale: Dehiscence is partial or complete separation of wound layers without protrusion
of organs (visible pink tissue indicates granulation, not viscera). Evisceration involves organ
protrusion and is a surgical emergency. This patient has dehiscence requiring sterile
dressing, NPO status, and surgical consultation—not immediate organ coverage unless
evisceration occurs.
Q9: Which patient is at highest risk for postoperative venous thromboembolism (VTE)?
A. 25-year-old undergoing laparoscopic appendectomy
B. 45-year-old having same-day arthroscopy
C. 68-year-old having total hip replacement with history of DVT [CORRECT]
D. 35-year-old scheduled for thyroidectomy
