Galen NUR 242 Exam 1 Actual Exam 2026/2027 –
Med-Surg Tested – Revised Rationalized Answers –
Pass Guaranteed – A+ Graded
Perioperative & Intraoperative Nursing Care
Q1: You're reviewing the preoperative assessment for a 68-year-old patient scheduled
for elective knee replacement. Which finding in their history requires the most
immediate communication with the surgical team?
A. History of seasonal allergies to pollen
B. Current use of warfarin with an INR of 3.8 [CORRECT]
C. Remote history of appendectomy 20 years ago
D. Mild anxiety about the procedure requiring reassurance
Correct Answer: B
Rationale: An INR of 3.8 indicates significantly prolonged clotting time and high
bleeding risk during surgery; warfarin typically needs to be held and bridged per
protocol. Option A is not relevant to surgery. Option C is remote history with no current
implications. Option D is expected and manageable with standard interventions.
Q2: During the intraoperative phase, the circulating nurse notices the patient's arm has
fallen off the armboard and is dangling below the level of the surgical table. What is the
most immediate concern?
A. Patient awareness during anesthesia
B. Nerve compression or stretch injury [CORRECT]
C. Increased risk of surgical site infection
D. Compromised airway patency
Correct Answer: B
Rationale: Arms positioned below the table level can cause brachial plexus stretch or
ulnar nerve compression due to gravitational pull and improper positioning. Option A
,relates to anesthesia depth, not positioning. Option C is unrelated to arm position.
Option D is not affected by arm positioning.
Q3: Postoperative day 1 after abdominal surgery, your patient reports pain at 8/10, has a
heart rate of 112, blood pressure 94/62, and urine output of 15 mL/hr for the past 3
hours. Which complication should you suspect first?
A. Paralytic ileus
B. Postoperative hemorrhage [CORRECT]
C. Wound dehiscence
D. Pulmonary embolism
Correct Answer: B
Rationale: Tachycardia, hypotension, and oliguria are classic signs of hypovolemic
shock from postoperative bleeding; this requires immediate assessment and
intervention. Option A presents with distention and absent bowel sounds. Option C
would show wound changes. Option D typically presents with respiratory symptoms and
hypoxia.
Q4: A patient is 4 hours post-op from a total hip arthroplasty. Which assessment finding
requires immediate notification of the surgeon?
A. Serous drainage on the surgical dressing measuring 2 cm
B. Shortness of breath and chest pain with SpO2 of 88% [CORRECT]
C. Pain rating of 6/10 one hour after receiving oral analgesic
D. Mild confusion that clears with reorientation
Correct Answer: B
Rationale: These symptoms suggest possible fat embolism or pulmonary embolism,
life-threatening complications requiring immediate intervention. Option A is minimal
expected drainage. Option C is inadequate pain control but not emergent. Option D is
common post-anesthesia and resolves.
Q5: When performing preoperative skin preparation, which action demonstrates correct
aseptic technique?
A. Shaving the surgical site the night before to allow skin recovery
B. Prepping from the incision site outward in circular motions [CORRECT]
C. Using the same prep sponge for the entire extremity without changing
D. Applying alcohol-based prep solution and allowing it to pool under the patient
, Correct Answer: B
Rationale: Prepping from clean (incision) to dirty (periphery) prevents contamination of
the surgical site. Option A causes microabrasions that increase infection risk. Option C
spreads microorganisms. Option D creates fire risk and skin irritation.
Q6: Your postoperative patient has a Jackson-Pratt drain with 150 mL of bright red
blood in the first hour after surgery. What is your priority nursing action?
A. Document the output and continue routine monitoring
B. Milk the drain tubing to ensure patency
C. Assess vital signs and notify the surgeon immediately [CORRECT]
D. Empty the drain and reinflate the bulb to full suction
Correct Answer: C
Rationale: 150 mL of bloody drainage in one hour indicates active hemorrhage; vital
signs assessment and immediate surgeon notification are critical. Option A
underestimates severity. Option B is inappropriate with active bleeding. Option D wastes
time and doesn't address the bleeding.
Q7: Which patient statement indicates adequate understanding of postoperative deep
breathing exercises?
A. "I'll hold my breath for 10 seconds every hour while awake."
B. "I need to splint my incision and take 3-5 deep breaths every hour while awake."
[CORRECT]
C. "Deep breathing is only necessary if I feel short of breath."
D. "I'll take deep breaths twice daily to prevent pneumonia."
Correct Answer: B
Rationale: Splinting supports the incision while hourly deep breathing prevents
atelectasis and pneumonia. Option A describes breath-holding, not ventilation. Option C
is reactive rather than preventive. Option D is insufficient frequency.
Q8: A patient is recovering from spinal anesthesia and reports a severe headache that
worsens when sitting up and improves when lying flat. Which intervention addresses the
most likely cause?
A. Administering a PRN opioid for headache pain
B. Increasing oral fluid intake and caffeine, preparing for possible blood patch
[CORRECT]
Med-Surg Tested – Revised Rationalized Answers –
Pass Guaranteed – A+ Graded
Perioperative & Intraoperative Nursing Care
Q1: You're reviewing the preoperative assessment for a 68-year-old patient scheduled
for elective knee replacement. Which finding in their history requires the most
immediate communication with the surgical team?
A. History of seasonal allergies to pollen
B. Current use of warfarin with an INR of 3.8 [CORRECT]
C. Remote history of appendectomy 20 years ago
D. Mild anxiety about the procedure requiring reassurance
Correct Answer: B
Rationale: An INR of 3.8 indicates significantly prolonged clotting time and high
bleeding risk during surgery; warfarin typically needs to be held and bridged per
protocol. Option A is not relevant to surgery. Option C is remote history with no current
implications. Option D is expected and manageable with standard interventions.
Q2: During the intraoperative phase, the circulating nurse notices the patient's arm has
fallen off the armboard and is dangling below the level of the surgical table. What is the
most immediate concern?
A. Patient awareness during anesthesia
B. Nerve compression or stretch injury [CORRECT]
C. Increased risk of surgical site infection
D. Compromised airway patency
Correct Answer: B
Rationale: Arms positioned below the table level can cause brachial plexus stretch or
ulnar nerve compression due to gravitational pull and improper positioning. Option A
,relates to anesthesia depth, not positioning. Option C is unrelated to arm position.
Option D is not affected by arm positioning.
Q3: Postoperative day 1 after abdominal surgery, your patient reports pain at 8/10, has a
heart rate of 112, blood pressure 94/62, and urine output of 15 mL/hr for the past 3
hours. Which complication should you suspect first?
A. Paralytic ileus
B. Postoperative hemorrhage [CORRECT]
C. Wound dehiscence
D. Pulmonary embolism
Correct Answer: B
Rationale: Tachycardia, hypotension, and oliguria are classic signs of hypovolemic
shock from postoperative bleeding; this requires immediate assessment and
intervention. Option A presents with distention and absent bowel sounds. Option C
would show wound changes. Option D typically presents with respiratory symptoms and
hypoxia.
Q4: A patient is 4 hours post-op from a total hip arthroplasty. Which assessment finding
requires immediate notification of the surgeon?
A. Serous drainage on the surgical dressing measuring 2 cm
B. Shortness of breath and chest pain with SpO2 of 88% [CORRECT]
C. Pain rating of 6/10 one hour after receiving oral analgesic
D. Mild confusion that clears with reorientation
Correct Answer: B
Rationale: These symptoms suggest possible fat embolism or pulmonary embolism,
life-threatening complications requiring immediate intervention. Option A is minimal
expected drainage. Option C is inadequate pain control but not emergent. Option D is
common post-anesthesia and resolves.
Q5: When performing preoperative skin preparation, which action demonstrates correct
aseptic technique?
A. Shaving the surgical site the night before to allow skin recovery
B. Prepping from the incision site outward in circular motions [CORRECT]
C. Using the same prep sponge for the entire extremity without changing
D. Applying alcohol-based prep solution and allowing it to pool under the patient
, Correct Answer: B
Rationale: Prepping from clean (incision) to dirty (periphery) prevents contamination of
the surgical site. Option A causes microabrasions that increase infection risk. Option C
spreads microorganisms. Option D creates fire risk and skin irritation.
Q6: Your postoperative patient has a Jackson-Pratt drain with 150 mL of bright red
blood in the first hour after surgery. What is your priority nursing action?
A. Document the output and continue routine monitoring
B. Milk the drain tubing to ensure patency
C. Assess vital signs and notify the surgeon immediately [CORRECT]
D. Empty the drain and reinflate the bulb to full suction
Correct Answer: C
Rationale: 150 mL of bloody drainage in one hour indicates active hemorrhage; vital
signs assessment and immediate surgeon notification are critical. Option A
underestimates severity. Option B is inappropriate with active bleeding. Option D wastes
time and doesn't address the bleeding.
Q7: Which patient statement indicates adequate understanding of postoperative deep
breathing exercises?
A. "I'll hold my breath for 10 seconds every hour while awake."
B. "I need to splint my incision and take 3-5 deep breaths every hour while awake."
[CORRECT]
C. "Deep breathing is only necessary if I feel short of breath."
D. "I'll take deep breaths twice daily to prevent pneumonia."
Correct Answer: B
Rationale: Splinting supports the incision while hourly deep breathing prevents
atelectasis and pneumonia. Option A describes breath-holding, not ventilation. Option C
is reactive rather than preventive. Option D is insufficient frequency.
Q8: A patient is recovering from spinal anesthesia and reports a severe headache that
worsens when sitting up and improves when lying flat. Which intervention addresses the
most likely cause?
A. Administering a PRN opioid for headache pain
B. Increasing oral fluid intake and caffeine, preparing for possible blood patch
[CORRECT]
