Galen NUR 265 – Med-Surg
Comprehensive Final (Exams 1–3 &
Final) 2026 250 Questions with Answers &
Rationales
EXAM 1: Perioperative, Wound Healing, Fluid/Electrolytes (Q1–50)
1. A patient is 2 hours post-op from a laparotomy. The nurse notes a heart
rate of 120 bpm, BP 85/50, and urine output of 15 mL over 2 hours. What is
the priority action?
A. Increase IV fluid rate
B. Notify the surgeon immediately
C. Administer prescribed antiemetic
D. Check the surgical dressing
Answer: B – Notify the surgeon immediately
Rationale: Tachycardia, hypotension, and oliguria suggest hypovolemic
shock from hemorrhage.
2. A patient post-op from a thyroidectomy reports difficulty breathing and a
sensation of throat fullness. The nurse observes swelling at the incision site.
What should the nurse do first?
A. Apply ice to the neck
B. Remove the surgical clips
C. Prepare for emergency tracheostomy setup
D. Elevate the head of bed
Answer: C – Prepare for emergency tracheostomy setup
Rationale: Post-thyroidectomy hematoma can cause airway compression;
emergency equipment needed.
,3. A patient received succinylcholine during surgery. One hour post-op, the
patient has a temperature of 105°F, muscle rigidity, and dark urine. What is
the priority?
A. Administer acetaminophen
B. Apply cooling blankets
C. Notify provider and prepare dantrolene
D. Increase IV fluids
Answer: C – Notify provider and prepare dantrolene
Rationale: Malignant hyperthermia is life-threatening; dantrolene is the
antidote.
4. A patient post-op from a total knee replacement has a new order for
rivaroxaban (Xarelto). The nurse knows this is given to:
A. Prevent infection
B. Reduce pain
C. Prevent deep vein thrombosis
D. Promote wound healing
Answer: C – Prevent deep vein thrombosis
Rationale: Rivaroxaban is a direct oral anticoagulant for DVT prophylaxis
post-orthopedic surgery.
5. A patient is 8 hours post-op and has not voided. The bladder scan shows
700 mL of urine. What should the nurse do?
A. Encourage oral fluids
B. Insert a straight catheter
C. Apply a warm compress
D. Wait another 4 hours
Answer: B – Insert a straight catheter
Rationale: Post-op urinary retention >600 mL requires catheterization to
prevent bladder overdistension.
6. A patient post-op from a gastrectomy has a nasogastric tube to low
intermittent suction. Which finding indicates possible tube obstruction?
A. Output of 300 mL green fluid in 4 hours
,B. Patient reports nausea and abdominal distention
C. Bowel sounds present
D. pH of aspirate is 5
Answer: B – Patient reports nausea and abdominal distention
Rationale: Obstruction causes decreased output with distention and nausea.
7. A patient received epidural anesthesia. Which finding requires immediate
intervention?
A. Blood pressure 95/65 mm Hg
B. Patient reports mild headache
C. Respiratory rate 6 breaths/min
D. Numbness in lower extremities
Answer: C – Respiratory rate 6 breaths/min
Rationale: Respiratory depression indicates high spinal or opioid toxicity;
emergency.
8. A patient post-op from a femoral fracture repair reports sudden chest
pain, dyspnea, and feels lightheaded. The nurse notes an SpO₂ of 84% on
room air. What is the priority?
A. Administer morphine
B. Apply oxygen and call rapid response
C. Obtain an ECG
D. Elevate the head of bed
Answer: B – Apply oxygen and call rapid response
Rationale: Suspected pulmonary embolism requires immediate oxygenation
and emergency team.
9. A patient is 18 hours post-op and has a temperature of 100.6°F (38.1°C).
The nurse’s best action is to:
A. Notify the surgeon immediately
B. Administer antipyretics
C. Encourage deep breathing and coughing
D. Obtain blood cultures
Answer: C – Encourage deep breathing and coughing
, Rationale: Low-grade fever in first 24 hours is often due to atelectasis; deep
breathing helps.
10. A patient post-op from a mastectomy has a Jackson-Pratt drain with 40
mL of serosanguineous drainage in 8 hours. The nurse should:
A. Notify the surgeon
B. Empty and measure the drain
C. Clamp the drain
D. Irrigate the drain with saline
Answer: B – Empty and measure the drain
Rationale: 40 mL in 8 hours is within expected range; routine drain care.
11. A patient is 3 days post-op and has a fever of 102.5°F, purulent drainage
from the incision, and erythema. What is the priority?
A. Obtain a wound culture
B. Administer antipyretics
C. Notify the provider and start antibiotics as ordered
D. Change the dressing
Answer: C – Notify the provider and start antibiotics as ordered
Rationale: Wound infection requires prompt antibiotic therapy.
12. A patient post-op from a cystectomy has a new ileal conduit. The stoma is
edematous and pale. What should the nurse do?
A. Apply a cool compress
B. Document as normal for day 1
C. Notify the surgeon immediately
D. Massage the stoma gently
Answer: C – Notify the surgeon immediately
Rationale: Pale/blue stoma indicates ischemia; surgical emergency.
13. Which patient is at highest risk for postoperative pneumonia?
A. 30-year-old with laparoscopic cholecystectomy
B. 75-year-old with COPD undergoing esophagectomy
C. 50-year-old with knee arthroscopy
D. 65-year-old with cataract surgery
Comprehensive Final (Exams 1–3 &
Final) 2026 250 Questions with Answers &
Rationales
EXAM 1: Perioperative, Wound Healing, Fluid/Electrolytes (Q1–50)
1. A patient is 2 hours post-op from a laparotomy. The nurse notes a heart
rate of 120 bpm, BP 85/50, and urine output of 15 mL over 2 hours. What is
the priority action?
A. Increase IV fluid rate
B. Notify the surgeon immediately
C. Administer prescribed antiemetic
D. Check the surgical dressing
Answer: B – Notify the surgeon immediately
Rationale: Tachycardia, hypotension, and oliguria suggest hypovolemic
shock from hemorrhage.
2. A patient post-op from a thyroidectomy reports difficulty breathing and a
sensation of throat fullness. The nurse observes swelling at the incision site.
What should the nurse do first?
A. Apply ice to the neck
B. Remove the surgical clips
C. Prepare for emergency tracheostomy setup
D. Elevate the head of bed
Answer: C – Prepare for emergency tracheostomy setup
Rationale: Post-thyroidectomy hematoma can cause airway compression;
emergency equipment needed.
,3. A patient received succinylcholine during surgery. One hour post-op, the
patient has a temperature of 105°F, muscle rigidity, and dark urine. What is
the priority?
A. Administer acetaminophen
B. Apply cooling blankets
C. Notify provider and prepare dantrolene
D. Increase IV fluids
Answer: C – Notify provider and prepare dantrolene
Rationale: Malignant hyperthermia is life-threatening; dantrolene is the
antidote.
4. A patient post-op from a total knee replacement has a new order for
rivaroxaban (Xarelto). The nurse knows this is given to:
A. Prevent infection
B. Reduce pain
C. Prevent deep vein thrombosis
D. Promote wound healing
Answer: C – Prevent deep vein thrombosis
Rationale: Rivaroxaban is a direct oral anticoagulant for DVT prophylaxis
post-orthopedic surgery.
5. A patient is 8 hours post-op and has not voided. The bladder scan shows
700 mL of urine. What should the nurse do?
A. Encourage oral fluids
B. Insert a straight catheter
C. Apply a warm compress
D. Wait another 4 hours
Answer: B – Insert a straight catheter
Rationale: Post-op urinary retention >600 mL requires catheterization to
prevent bladder overdistension.
6. A patient post-op from a gastrectomy has a nasogastric tube to low
intermittent suction. Which finding indicates possible tube obstruction?
A. Output of 300 mL green fluid in 4 hours
,B. Patient reports nausea and abdominal distention
C. Bowel sounds present
D. pH of aspirate is 5
Answer: B – Patient reports nausea and abdominal distention
Rationale: Obstruction causes decreased output with distention and nausea.
7. A patient received epidural anesthesia. Which finding requires immediate
intervention?
A. Blood pressure 95/65 mm Hg
B. Patient reports mild headache
C. Respiratory rate 6 breaths/min
D. Numbness in lower extremities
Answer: C – Respiratory rate 6 breaths/min
Rationale: Respiratory depression indicates high spinal or opioid toxicity;
emergency.
8. A patient post-op from a femoral fracture repair reports sudden chest
pain, dyspnea, and feels lightheaded. The nurse notes an SpO₂ of 84% on
room air. What is the priority?
A. Administer morphine
B. Apply oxygen and call rapid response
C. Obtain an ECG
D. Elevate the head of bed
Answer: B – Apply oxygen and call rapid response
Rationale: Suspected pulmonary embolism requires immediate oxygenation
and emergency team.
9. A patient is 18 hours post-op and has a temperature of 100.6°F (38.1°C).
The nurse’s best action is to:
A. Notify the surgeon immediately
B. Administer antipyretics
C. Encourage deep breathing and coughing
D. Obtain blood cultures
Answer: C – Encourage deep breathing and coughing
, Rationale: Low-grade fever in first 24 hours is often due to atelectasis; deep
breathing helps.
10. A patient post-op from a mastectomy has a Jackson-Pratt drain with 40
mL of serosanguineous drainage in 8 hours. The nurse should:
A. Notify the surgeon
B. Empty and measure the drain
C. Clamp the drain
D. Irrigate the drain with saline
Answer: B – Empty and measure the drain
Rationale: 40 mL in 8 hours is within expected range; routine drain care.
11. A patient is 3 days post-op and has a fever of 102.5°F, purulent drainage
from the incision, and erythema. What is the priority?
A. Obtain a wound culture
B. Administer antipyretics
C. Notify the provider and start antibiotics as ordered
D. Change the dressing
Answer: C – Notify the provider and start antibiotics as ordered
Rationale: Wound infection requires prompt antibiotic therapy.
12. A patient post-op from a cystectomy has a new ileal conduit. The stoma is
edematous and pale. What should the nurse do?
A. Apply a cool compress
B. Document as normal for day 1
C. Notify the surgeon immediately
D. Massage the stoma gently
Answer: C – Notify the surgeon immediately
Rationale: Pale/blue stoma indicates ischemia; surgical emergency.
13. Which patient is at highest risk for postoperative pneumonia?
A. 30-year-old with laparoscopic cholecystectomy
B. 75-year-old with COPD undergoing esophagectomy
C. 50-year-old with knee arthroscopy
D. 65-year-old with cataract surgery
