Galen NUR 265 – Med-Surg Exam 2 (Two
Versions) 2026 Version A – Questions 1–75 |
Version B – Questions 76–150 Answers &
Rationales Included
VERSION A (Questions 1–75)
Section A1: Perioperative & Postoperative Complications (Q1–15)
1. A patient is 4 hours post-op from open abdominal surgery.
Which finding suggests early hypovolemic shock?
A. Urine output 35 mL/hr
B. Heart rate 118 bpm, BP 90/60
C. Pain score 6/10
D. Temperature 99.2°F (37.3°C)
Answer: B – Heart rate 118 bpm, BP 90/60
Rationale: Tachycardia with hypotension indicates hypovolemia
until proven otherwise.
2. A patient post-op from hip replacement suddenly reports
“something popped” in the incision, and the nurse sees bowel
loops. What is the priority action?
A. Push the bowel back in
B. Cover with sterile saline-moistened dressing
C. Apply an abdominal binder tightly
D. Place patient in Trendelenburg
Answer: B – Cover with sterile saline-moistened dressing
Rationale: Evisceration requires moist sterile dressing; never
reinsert organs.
,3. Which patient is at highest risk for malignant hyperthermia?
A. 22-year-old with family history of MH, receiving sevoflurane
B. 65-year-old with hypertension on beta-blockers
C. 40-year-old with diabetes receiving propofol
D. 30-year-old with asthma receiving ketamine
Answer: A – 22-year-old with family history of MH, receiving
sevoflurane
Rationale: MH is autosomal dominant triggered by volatile
anesthetics/succinylcholine.
4. A patient post-op from thyroidectomy reports tingling around
the mouth and finger twitching. Which lab value should the nurse
expect?
A. Calcium 6.8 mg/dL
B. Potassium 5.5 mEq/L
C. Sodium 155 mEq/L
D. Magnesium 2.5 mg/dL
Answer: A – Calcium 6.8 mg/dL
Rationale: Tetany indicates hypocalcemia from parathyroid injury.
5. A patient has a Jackson-Pratt drain with 200 mL bright red blood
in 2 hours. The nurse should:
A. Empty and reapply suction
B. Notify the surgeon immediately
C. Document as normal
D. Irrigate the drain
Answer: B – Notify the surgeon immediately
*Rationale: >100 mL/hr suggests hemorrhage.*
,6. Which finding in the first 24 hours post-op is most indicative of
atelectasis?
A. Purulent sputum
B. Low-grade fever and crackles that clear with coughing
C. Chest pain with inspiration
D. Oxygen saturation 85%
Answer: B – Low-grade fever and crackles that clear with coughing
Rationale: Atelectasis causes fever and crackles that often clear
after deep breathing.
7. A patient received spinal anesthesia. Which finding requires
immediate action?
A. Blood pressure 100/70
B. Patient reports headache when sitting up
C. Respiratory rate 8 breaths/min
D. Urinary retention
Answer: C – Respiratory rate 8 breaths/min
Rationale: High spinal can cause respiratory depression;
emergency.
8. A patient post-op has not voided for 10 hours and has suprapubic
discomfort. What should the nurse do first?
A. Insert a Foley catheter
B. Perform a bladder scan
C. Increase IV fluids
D. Palpate the bladder
Answer: B – Perform a bladder scan
Rationale: Bladder scan determines retention non-invasively.
, 9. Which medication is used to reverse the effects of vecuronium
(neuromuscular blocker)?
A. Naloxone
B. Neostigmine
C. Flumazenil
D. Protamine
Answer: B – Neostigmine
Rationale: Neostigmine with glycopyrrolate reverses
non-depolarizing NMBs.
10. A patient post-op from bowel resection has a new colostomy.
The stoma is pale and bluish. What should the nurse do?
A. Apply warm compress
B. Notify surgeon immediately
C. Document as normal
D. Massage the stoma
Answer: B – Notify surgeon immediately
Rationale: Pale/blue stoma indicates ischemia or necrosis.
11. A patient is 1 day post-op and has a fever of 101.5°F (38.6°C),
crackles in lung bases, and a productive cough. The nurse suspects:
A. Wound infection
B. Atelectasis progressing to pneumonia
C. Urinary tract infection
D. Deep vein thrombosis
Answer: B – Atelectasis progressing to pneumonia
Rationale: Post-op day 1 fever often atelectasis; productive cough
suggests infection.
Versions) 2026 Version A – Questions 1–75 |
Version B – Questions 76–150 Answers &
Rationales Included
VERSION A (Questions 1–75)
Section A1: Perioperative & Postoperative Complications (Q1–15)
1. A patient is 4 hours post-op from open abdominal surgery.
Which finding suggests early hypovolemic shock?
A. Urine output 35 mL/hr
B. Heart rate 118 bpm, BP 90/60
C. Pain score 6/10
D. Temperature 99.2°F (37.3°C)
Answer: B – Heart rate 118 bpm, BP 90/60
Rationale: Tachycardia with hypotension indicates hypovolemia
until proven otherwise.
2. A patient post-op from hip replacement suddenly reports
“something popped” in the incision, and the nurse sees bowel
loops. What is the priority action?
A. Push the bowel back in
B. Cover with sterile saline-moistened dressing
C. Apply an abdominal binder tightly
D. Place patient in Trendelenburg
Answer: B – Cover with sterile saline-moistened dressing
Rationale: Evisceration requires moist sterile dressing; never
reinsert organs.
,3. Which patient is at highest risk for malignant hyperthermia?
A. 22-year-old with family history of MH, receiving sevoflurane
B. 65-year-old with hypertension on beta-blockers
C. 40-year-old with diabetes receiving propofol
D. 30-year-old with asthma receiving ketamine
Answer: A – 22-year-old with family history of MH, receiving
sevoflurane
Rationale: MH is autosomal dominant triggered by volatile
anesthetics/succinylcholine.
4. A patient post-op from thyroidectomy reports tingling around
the mouth and finger twitching. Which lab value should the nurse
expect?
A. Calcium 6.8 mg/dL
B. Potassium 5.5 mEq/L
C. Sodium 155 mEq/L
D. Magnesium 2.5 mg/dL
Answer: A – Calcium 6.8 mg/dL
Rationale: Tetany indicates hypocalcemia from parathyroid injury.
5. A patient has a Jackson-Pratt drain with 200 mL bright red blood
in 2 hours. The nurse should:
A. Empty and reapply suction
B. Notify the surgeon immediately
C. Document as normal
D. Irrigate the drain
Answer: B – Notify the surgeon immediately
*Rationale: >100 mL/hr suggests hemorrhage.*
,6. Which finding in the first 24 hours post-op is most indicative of
atelectasis?
A. Purulent sputum
B. Low-grade fever and crackles that clear with coughing
C. Chest pain with inspiration
D. Oxygen saturation 85%
Answer: B – Low-grade fever and crackles that clear with coughing
Rationale: Atelectasis causes fever and crackles that often clear
after deep breathing.
7. A patient received spinal anesthesia. Which finding requires
immediate action?
A. Blood pressure 100/70
B. Patient reports headache when sitting up
C. Respiratory rate 8 breaths/min
D. Urinary retention
Answer: C – Respiratory rate 8 breaths/min
Rationale: High spinal can cause respiratory depression;
emergency.
8. A patient post-op has not voided for 10 hours and has suprapubic
discomfort. What should the nurse do first?
A. Insert a Foley catheter
B. Perform a bladder scan
C. Increase IV fluids
D. Palpate the bladder
Answer: B – Perform a bladder scan
Rationale: Bladder scan determines retention non-invasively.
, 9. Which medication is used to reverse the effects of vecuronium
(neuromuscular blocker)?
A. Naloxone
B. Neostigmine
C. Flumazenil
D. Protamine
Answer: B – Neostigmine
Rationale: Neostigmine with glycopyrrolate reverses
non-depolarizing NMBs.
10. A patient post-op from bowel resection has a new colostomy.
The stoma is pale and bluish. What should the nurse do?
A. Apply warm compress
B. Notify surgeon immediately
C. Document as normal
D. Massage the stoma
Answer: B – Notify surgeon immediately
Rationale: Pale/blue stoma indicates ischemia or necrosis.
11. A patient is 1 day post-op and has a fever of 101.5°F (38.6°C),
crackles in lung bases, and a productive cough. The nurse suspects:
A. Wound infection
B. Atelectasis progressing to pneumonia
C. Urinary tract infection
D. Deep vein thrombosis
Answer: B – Atelectasis progressing to pneumonia
Rationale: Post-op day 1 fever often atelectasis; productive cough
suggests infection.
