NUR242 EXAM 1 NEW 2026/2027 | Medical-Surgical Nursing
Exam Review | Complete Guide with Questions & Verified
Answers 100% Correct | Galen | Pass Guaranteed - A+
Graded
Section 1: Perioperative Nursing Review—Before, During, and After Surgery
Q1: Your patient is scheduled for elective gallbladder surgery at 10:00 AM. The
preoperative orders state NPO after midnight. The patient admits to eating toast at 6:00
AM. What is the priority nursing action?
A. Proceed with surgery as scheduled
B. Notify the surgeon and anesthesia immediately [CORRECT]
C. Give the patient water to help digestion
D. Reschedule the surgery without consulting the surgeon
Correct Answer: B
Rationale: For the NUR242 Exam 1 Review, remember that solid food within 6-8 hours of
surgery significantly increases aspiration risk—this requires immediate notification to
the surgical team for decision-making. Only the surgeon can cancel or delay the
procedure; nurses don't make that call independently, and giving water worsens the
situation.
Q2: During the preoperative assessment, your patient reveals they take warfarin daily for
atrial fibrillation. The surgery is scheduled for tomorrow. Which question is most
important to ask?
,A. "Have you had any bleeding gums?"
B. "When was your last INR level and what was the result?" [CORRECT]
C. "Do you take your medication with food?"
D. "Have you ever had a blood clot?"
Correct Answer: B
Rationale: That's correct because perioperative anticoagulation management depends
on recent INR—warfarin typically held 5 days before surgery with bridging or INR check.
Bleeding gums are relevant but less critical than knowing if INR is therapeutic or
supratherapeutic; timing and food are routine questions; history of clots is important but
doesn't guide immediate preop management.
Q3: In the operating room, the circulating nurse observes the surgical technologist reach
over the sterile field to grab a dropped instrument. What is the appropriate action?
A. Say nothing if the technologist is experienced
B. Stop the procedure immediately and call a code
C. Address the break in sterile technique and replace contaminated items [CORRECT]
D. Document the incident after surgery only
Correct Answer: C
Rationale: The priority action is immediate correction of sterile technique
breaches—reaching over the field contaminates it. This isn't a code situation, but it does
require stopping to fix the problem and replace anything potentially contaminated.
Silence or delayed documentation allows infection risk to continue.
Q4: Your postoperative patient in PACU has a blood pressure of 88/52 mmHg, heart rate
118 bpm, and cool, clammy skin. The surgical dressing has a 4cm area of sanguineous
drainage that wasn't present 15 minutes ago. What complication is suspected?
,A. Wound infection
B. Hemorrhage/shock [CORRECT]
C. Atelectasis
D. Urinary retention
Correct Answer: B
Rationale: This is classic hemorrhagic shock—tachycardia, hypotension, cool/clammy
skin (sympathetic response), and expanding sanguineous drainage indicate active
bleeding. A common mistake is focusing only on the dressing change, but the vital
signs and perfusion status tell the real story here.
Q5: Postoperative day 2, your patient develops sudden dyspnea, tachypnea, pleuritic
chest pain, and oxygen saturation of 88% on room air. What complication is highest on
your differential?
A. Pneumonia
B. Pulmonary embolism [CORRECT]
C. Atelectasis
D. Hypovolemia
Correct Answer: B
Rationale: The sudden onset dyspnea, pleuritic pain, and hypoxia in a postoperative
patient (stasis, hypercoagulability, endothelial injury = Virchow's triad) screams
pulmonary embolism until proven otherwise. Pneumonia develops more gradually;
atelectasis causes gradual hypoxia without sharp pain; hypovolemia doesn't cause
pleuritic symptoms.
Q6: Your patient is receiving morphine via PCA pump. Their respiratory rate drops to 8
breaths per minute with oxygen saturation 90%. What is the priority intervention?
, A. Encourage deep breathing exercises
B. Administer naloxone per protocol and prepare to reduce or stop opioid [CORRECT]
C. Increase the PCA lockout interval
D. Switch to oral oxycodone
Correct Answer: B
Rationale: Respiratory rate 8 with desaturation indicates significant opioid-induced
respiratory depression—naloxone is the antidote and safety priority. Deep breathing
won't overcome opioid effect; changing pump settings or route doesn't address
immediate life-threatening depression.
Q7: Using the PQRST mnemonic for pain assessment, the "T" stands for:
A. Type of pain (sharp, dull, burning)
B. Timing (onset, duration, frequency) [CORRECT]
C. Treatment tried and effectiveness
D. Tenderness to palpation
Correct Answer: B
Rationale: For the NUR242 Exam 1 Review, remember PQRST: Provocation/Palliation,
Quality, Region/Radiation, Severity, and Timing. Timing captures when it started, how
long it lasts, and if it's constant or intermittent—critical for surgical pain (incisional vs.
colicky vs. referred).
Q8: Your postoperative patient has absent bowel sounds, abdominal distension, and has
not passed flatus in 48 hours. They are nauseated and vomiting bilious material. This
indicates:
A. Normal postoperative ileus
B. Paralytic ileus requiring NG decompression and NPO status [CORRECT]
C. Wound dehiscence
Exam Review | Complete Guide with Questions & Verified
Answers 100% Correct | Galen | Pass Guaranteed - A+
Graded
Section 1: Perioperative Nursing Review—Before, During, and After Surgery
Q1: Your patient is scheduled for elective gallbladder surgery at 10:00 AM. The
preoperative orders state NPO after midnight. The patient admits to eating toast at 6:00
AM. What is the priority nursing action?
A. Proceed with surgery as scheduled
B. Notify the surgeon and anesthesia immediately [CORRECT]
C. Give the patient water to help digestion
D. Reschedule the surgery without consulting the surgeon
Correct Answer: B
Rationale: For the NUR242 Exam 1 Review, remember that solid food within 6-8 hours of
surgery significantly increases aspiration risk—this requires immediate notification to
the surgical team for decision-making. Only the surgeon can cancel or delay the
procedure; nurses don't make that call independently, and giving water worsens the
situation.
Q2: During the preoperative assessment, your patient reveals they take warfarin daily for
atrial fibrillation. The surgery is scheduled for tomorrow. Which question is most
important to ask?
,A. "Have you had any bleeding gums?"
B. "When was your last INR level and what was the result?" [CORRECT]
C. "Do you take your medication with food?"
D. "Have you ever had a blood clot?"
Correct Answer: B
Rationale: That's correct because perioperative anticoagulation management depends
on recent INR—warfarin typically held 5 days before surgery with bridging or INR check.
Bleeding gums are relevant but less critical than knowing if INR is therapeutic or
supratherapeutic; timing and food are routine questions; history of clots is important but
doesn't guide immediate preop management.
Q3: In the operating room, the circulating nurse observes the surgical technologist reach
over the sterile field to grab a dropped instrument. What is the appropriate action?
A. Say nothing if the technologist is experienced
B. Stop the procedure immediately and call a code
C. Address the break in sterile technique and replace contaminated items [CORRECT]
D. Document the incident after surgery only
Correct Answer: C
Rationale: The priority action is immediate correction of sterile technique
breaches—reaching over the field contaminates it. This isn't a code situation, but it does
require stopping to fix the problem and replace anything potentially contaminated.
Silence or delayed documentation allows infection risk to continue.
Q4: Your postoperative patient in PACU has a blood pressure of 88/52 mmHg, heart rate
118 bpm, and cool, clammy skin. The surgical dressing has a 4cm area of sanguineous
drainage that wasn't present 15 minutes ago. What complication is suspected?
,A. Wound infection
B. Hemorrhage/shock [CORRECT]
C. Atelectasis
D. Urinary retention
Correct Answer: B
Rationale: This is classic hemorrhagic shock—tachycardia, hypotension, cool/clammy
skin (sympathetic response), and expanding sanguineous drainage indicate active
bleeding. A common mistake is focusing only on the dressing change, but the vital
signs and perfusion status tell the real story here.
Q5: Postoperative day 2, your patient develops sudden dyspnea, tachypnea, pleuritic
chest pain, and oxygen saturation of 88% on room air. What complication is highest on
your differential?
A. Pneumonia
B. Pulmonary embolism [CORRECT]
C. Atelectasis
D. Hypovolemia
Correct Answer: B
Rationale: The sudden onset dyspnea, pleuritic pain, and hypoxia in a postoperative
patient (stasis, hypercoagulability, endothelial injury = Virchow's triad) screams
pulmonary embolism until proven otherwise. Pneumonia develops more gradually;
atelectasis causes gradual hypoxia without sharp pain; hypovolemia doesn't cause
pleuritic symptoms.
Q6: Your patient is receiving morphine via PCA pump. Their respiratory rate drops to 8
breaths per minute with oxygen saturation 90%. What is the priority intervention?
, A. Encourage deep breathing exercises
B. Administer naloxone per protocol and prepare to reduce or stop opioid [CORRECT]
C. Increase the PCA lockout interval
D. Switch to oral oxycodone
Correct Answer: B
Rationale: Respiratory rate 8 with desaturation indicates significant opioid-induced
respiratory depression—naloxone is the antidote and safety priority. Deep breathing
won't overcome opioid effect; changing pump settings or route doesn't address
immediate life-threatening depression.
Q7: Using the PQRST mnemonic for pain assessment, the "T" stands for:
A. Type of pain (sharp, dull, burning)
B. Timing (onset, duration, frequency) [CORRECT]
C. Treatment tried and effectiveness
D. Tenderness to palpation
Correct Answer: B
Rationale: For the NUR242 Exam 1 Review, remember PQRST: Provocation/Palliation,
Quality, Region/Radiation, Severity, and Timing. Timing captures when it started, how
long it lasts, and if it's constant or intermittent—critical for surgical pain (incisional vs.
colicky vs. referred).
Q8: Your postoperative patient has absent bowel sounds, abdominal distension, and has
not passed flatus in 48 hours. They are nauseated and vomiting bilious material. This
indicates:
A. Normal postoperative ileus
B. Paralytic ileus requiring NG decompression and NPO status [CORRECT]
C. Wound dehiscence
