NUR 209 Medical Surgical Nursing II
Exam 1: Comprehensive Assessment
2024/2025 Update | Fortis College
Instructions: Read each question carefully. Select the best answer(s) for each item. For select-
all-that-apply (SATA) questions, choose all options that apply. For ordered response questions,
arrange interventions in priority order.
DOMAIN 1: PERIOPERATIVE NURSING (12 Questions)
Question 1 (Multiple-Choice)
A 68-year-old patient is scheduled for an elective total knee arthroplasty. The surgeon explains
the procedure and obtains the patient's signature on the informed consent form. The nurse's
primary responsibility regarding informed consent is to:
A. Explain the risks and benefits of the procedure in detail. B. Witness the patient's signature
and verify that the patient understands the information provided. C. Obtain the patient's
signature if the surgeon is unavailable. D. Determine whether the patient is competent to
provide consent.
Answer: B [CORRECT]
Rationale: Informed consent must be obtained by the provider performing the procedure; the
nurse's role is to witness the signature and ensure the patient understands what was explained.
The nurse does not explain risks/benefits (provider role), obtain consent independently, or
determine competency (legal/medical determination). Verifying understanding and witnessing
the signature ensures legal and ethical compliance.
Question 2 (Select-All-That-Apply)
A nurse is completing preoperative teaching for a 55-year-old patient scheduled for laparoscopic
cholecystectomy. Which statements by the nurse are appropriate? (Select all that apply.)
A. "You will need to use your incentive spirometer 10 times every hour while awake after
surgery." B. "You should not eat or drink anything after midnight the night before your surgery."
,C. "I will administer your blood pressure medication with a small sip of water on the morning of
surgery." D. "You will be fully awake and able to walk immediately after the procedure." E.
"Deep breathing and coughing exercises help prevent lung complications after anesthesia."
Answer: A, B, C, E [CORRECT]
Rationale: Preoperative teaching includes incentive spirometry use (A), NPO status (B),
medication administration per anesthesia protocol (C), and education on TCDB to prevent
atelectasis (E). Statement D is incorrect because patients require recovery time from anesthesia
and are not immediately fully awake or ambulatory post-procedure.
Question 3 (Multiple-Choice)
A preoperative nurse is assessing a 72-year-old patient with a history of chronic obstructive
pulmonary disease (COPD) who is scheduled for open abdominal surgery. Which finding
requires immediate notification of the surgeon prior to proceeding?
A. Blood pressure 148/92 mmHg B. Respiratory rate 24 breaths/min with productive cough and
fever of 101.2°F C. Potassium level 3.6 mEq/L D. Blood glucose 142 mg/dL
Answer: B [CORRECT]
Rationale: A respiratory rate of 24 with productive cough and fever indicates a possible
respiratory infection, which significantly increases the risk of postoperative pneumonia and
atelectasis, particularly in a patient with COPD undergoing abdominal surgery. This requires
evaluation and possible postponement. Elevated BP (A), normal potassium (C), and mildly
elevated glucose (D) are not immediate surgical contraindications.
Sub-Topic: Intraoperative Roles and Malignant Hyperthermia (3 Questions)
Question 4 (Multiple-Choice)
During a surgical procedure, the circulating nurse notes that the patient's temperature has risen
from 37.0°C to 39.8°C over 20 minutes, heart rate is 142 bpm, and end-tidal CO2 is elevated.
The patient has received succinylcholine and isoflurane. The nurse should anticipate
administration of:
A. Atropine sulfate B. Dantrolene sodium C. Protamine sulfate D. Sodium bicarbonate
Answer: B [CORRECT]
, Rationale: Malignant hyperthermia is a life-threatening hypermetabolic reaction triggered by
volatile anesthetics and succinylcholine. Classic signs include rapid temperature elevation,
tachycardia, muscle rigidity, and increased ETCO2. Dantrolene sodium is the specific antidote
that inhibits calcium release from the sarcoplasmic reticulum, halting the hypermetabolic
cascade. Immediate treatment also includes discontinuing triggering agents, 100% oxygen,
cooling measures, and correction of acidosis.
Question 5 (Multiple-Choice)
The scrub nurse's primary responsibility during surgery includes:
A. Managing anesthesia equipment and monitoring the patient's vital signs B. Maintaining
sterile technique and passing instruments to the surgeon C. Documenting nursing care and
coordinating personnel in the operating room D. Positioning the patient and applying grounding
pads for electrocautery
Answer: B [CORRECT]
Rationale: The scrub nurse maintains sterile technique throughout the procedure, prepares the
sterile field, and passes instruments and supplies to the surgeon. Managing anesthesia (A) is the
anesthesia provider's role; documenting and coordinating (C) and positioning/grounding (D) are
responsibilities of the circulating nurse (unsterile role).
Question 6 (Select-All-That-Apply)
A nurse is caring for a patient in the post-anesthesia care unit (PACU) who is at risk for
malignant hyperthermia. Which interventions should the nurse include in the plan of care?
(Select all that apply.)
A. Maintain availability of dantrolene sodium in the surgical suite B. Monitor temperature
continuously using a core temperature probe C. Administer prophylactic dantrolene to all
patients receiving general anesthesia D. Ensure anesthesia machine has been flushed with 100%
oxygen for at least 10 minutes if previous patient received triggering agents E. Keep ice packs
and cooling blankets readily accessible
Answer: A, B, D, E [CORRECT]
Rationale: Malignant hyperthermia preparedness includes maintaining dantrolene availability
(A), continuous core temperature monitoring (B), flushing anesthesia machines to remove
residual triggering agents (D), and having cooling equipment accessible (E). Prophylactic
Exam 1: Comprehensive Assessment
2024/2025 Update | Fortis College
Instructions: Read each question carefully. Select the best answer(s) for each item. For select-
all-that-apply (SATA) questions, choose all options that apply. For ordered response questions,
arrange interventions in priority order.
DOMAIN 1: PERIOPERATIVE NURSING (12 Questions)
Question 1 (Multiple-Choice)
A 68-year-old patient is scheduled for an elective total knee arthroplasty. The surgeon explains
the procedure and obtains the patient's signature on the informed consent form. The nurse's
primary responsibility regarding informed consent is to:
A. Explain the risks and benefits of the procedure in detail. B. Witness the patient's signature
and verify that the patient understands the information provided. C. Obtain the patient's
signature if the surgeon is unavailable. D. Determine whether the patient is competent to
provide consent.
Answer: B [CORRECT]
Rationale: Informed consent must be obtained by the provider performing the procedure; the
nurse's role is to witness the signature and ensure the patient understands what was explained.
The nurse does not explain risks/benefits (provider role), obtain consent independently, or
determine competency (legal/medical determination). Verifying understanding and witnessing
the signature ensures legal and ethical compliance.
Question 2 (Select-All-That-Apply)
A nurse is completing preoperative teaching for a 55-year-old patient scheduled for laparoscopic
cholecystectomy. Which statements by the nurse are appropriate? (Select all that apply.)
A. "You will need to use your incentive spirometer 10 times every hour while awake after
surgery." B. "You should not eat or drink anything after midnight the night before your surgery."
,C. "I will administer your blood pressure medication with a small sip of water on the morning of
surgery." D. "You will be fully awake and able to walk immediately after the procedure." E.
"Deep breathing and coughing exercises help prevent lung complications after anesthesia."
Answer: A, B, C, E [CORRECT]
Rationale: Preoperative teaching includes incentive spirometry use (A), NPO status (B),
medication administration per anesthesia protocol (C), and education on TCDB to prevent
atelectasis (E). Statement D is incorrect because patients require recovery time from anesthesia
and are not immediately fully awake or ambulatory post-procedure.
Question 3 (Multiple-Choice)
A preoperative nurse is assessing a 72-year-old patient with a history of chronic obstructive
pulmonary disease (COPD) who is scheduled for open abdominal surgery. Which finding
requires immediate notification of the surgeon prior to proceeding?
A. Blood pressure 148/92 mmHg B. Respiratory rate 24 breaths/min with productive cough and
fever of 101.2°F C. Potassium level 3.6 mEq/L D. Blood glucose 142 mg/dL
Answer: B [CORRECT]
Rationale: A respiratory rate of 24 with productive cough and fever indicates a possible
respiratory infection, which significantly increases the risk of postoperative pneumonia and
atelectasis, particularly in a patient with COPD undergoing abdominal surgery. This requires
evaluation and possible postponement. Elevated BP (A), normal potassium (C), and mildly
elevated glucose (D) are not immediate surgical contraindications.
Sub-Topic: Intraoperative Roles and Malignant Hyperthermia (3 Questions)
Question 4 (Multiple-Choice)
During a surgical procedure, the circulating nurse notes that the patient's temperature has risen
from 37.0°C to 39.8°C over 20 minutes, heart rate is 142 bpm, and end-tidal CO2 is elevated.
The patient has received succinylcholine and isoflurane. The nurse should anticipate
administration of:
A. Atropine sulfate B. Dantrolene sodium C. Protamine sulfate D. Sodium bicarbonate
Answer: B [CORRECT]
, Rationale: Malignant hyperthermia is a life-threatening hypermetabolic reaction triggered by
volatile anesthetics and succinylcholine. Classic signs include rapid temperature elevation,
tachycardia, muscle rigidity, and increased ETCO2. Dantrolene sodium is the specific antidote
that inhibits calcium release from the sarcoplasmic reticulum, halting the hypermetabolic
cascade. Immediate treatment also includes discontinuing triggering agents, 100% oxygen,
cooling measures, and correction of acidosis.
Question 5 (Multiple-Choice)
The scrub nurse's primary responsibility during surgery includes:
A. Managing anesthesia equipment and monitoring the patient's vital signs B. Maintaining
sterile technique and passing instruments to the surgeon C. Documenting nursing care and
coordinating personnel in the operating room D. Positioning the patient and applying grounding
pads for electrocautery
Answer: B [CORRECT]
Rationale: The scrub nurse maintains sterile technique throughout the procedure, prepares the
sterile field, and passes instruments and supplies to the surgeon. Managing anesthesia (A) is the
anesthesia provider's role; documenting and coordinating (C) and positioning/grounding (D) are
responsibilities of the circulating nurse (unsterile role).
Question 6 (Select-All-That-Apply)
A nurse is caring for a patient in the post-anesthesia care unit (PACU) who is at risk for
malignant hyperthermia. Which interventions should the nurse include in the plan of care?
(Select all that apply.)
A. Maintain availability of dantrolene sodium in the surgical suite B. Monitor temperature
continuously using a core temperature probe C. Administer prophylactic dantrolene to all
patients receiving general anesthesia D. Ensure anesthesia machine has been flushed with 100%
oxygen for at least 10 minutes if previous patient received triggering agents E. Keep ice packs
and cooling blankets readily accessible
Answer: A, B, D, E [CORRECT]
Rationale: Malignant hyperthermia preparedness includes maintaining dantrolene availability
(A), continuous core temperature monitoring (B), flushing anesthesia machines to remove
residual triggering agents (D), and having cooling equipment accessible (E). Prophylactic
