NUR 209 Medical Surgical Nursing
II Exam 1 Actual Exam 2026/2027
Fortis College Complete
Questions & Detailed Rationales -
Pass Guaranteed - A+ Graded
Perioperative Nursing & Surgical Complications – 10 questions
Q1: The nurse is preparing a patient for surgery scheduled for 0800. The patient takes
warfarin (Coumadin) daily for atrial fibrillation. What is the most important question the
nurse should ask the patient during the preoperative assessment?
A. "Do you have any allergies to latex or iodine?"
B. "When was the last time you took your warfarin?"
C. "Have you had anything to eat or drink since midnight?"
D. "Are you experiencing any chest pain or palpitations?"
Correct Answer: B
Rationale: This choice is correct because anticoagulants like warfarin significantly
increase the risk of intraoperative and postoperative bleeding. The nurse must
determine when the last dose was taken to assess if the patient's INR is safe for
surgery, as the provider typically holds warfarin several days prior. While allergies, NPO
status, and cardiac symptoms are important, managing the bleeding risk is the
immediate priority for a patient on anticoagulants.
Q2: During the preoperative teaching session, the nurse is instructing the patient on the
use of an incentive spirometer. Which statement by the patient indicates a need for
further teaching?
A. "I should place the mouthpiece in my mouth and seal my lips tightly around it."
B. "I need to breathe in slowly and deeply to try to get the piston to rise to the goal
marker."
C. "I will perform this exercise every hour while I am awake."
D. "I should exhale quickly into the device to make the ball go up as high as possible."
Correct Answer: D
,Rationale: This choice is correct because the incentive spirometer requires slow, deep
inhalation to sustain lung expansion and prevent atelectasis; exhaling quickly into the
device is incorrect technique and will not achieve the desired therapeutic effect. The
other statements reflect proper use of the device, including creating a seal, slow
inhalation, and frequency of use.
Q3: The circulating nurse in the operating room is responsible for which of the following
primary duties?
A. Passing sterile instruments to the surgeon.
B. Managing the surgical draping of the patient.
C. Coordinating the overall care of the patient in the OR and maintaining a safe
environment.
D. Administering general anesthesia and monitoring the patient's airway.
Correct Answer: C
Rationale: This choice is correct because the circulating nurse is a non-sterile role
responsible for managing the overall nursing care in the OR, documenting, checking
safety protocols, and coordinating the team. Passing instruments is the scrub nurse's
role, and administering anesthesia is the anesthesiologist or CRNA's responsibility.
Q4: A patient returns to the surgical unit following a total hip arthroplasty. The nurse
assesses the patient and finds the vital signs are BP 85/55 mmHg, HR 120 bpm, RR 24
bpm, and SpO2 90% on room air. The surgical dressing is dry and intact. What is the
nurse's priority action?
A. Elevate the lower extremities and apply warm blankets.
B. Increase the IV fluid rate to 200 mL/hr and reassess in 15 minutes.
C. Administer the prescribed PRN pain medication.
D. Check the patient's oxygen saturation with a pulse oximeter and apply oxygen.
Correct Answer: D
Rationale: This choice is correct because hypoxia (SpO2 90%) is a critical threat to life
and must be addressed immediately using the ABC (Airway, Breathing, Circulation)
framework. While hypotension and tachycardia suggest possible hypovolemia or shock,
correcting hypoxia takes precedence to prevent further cardiac or cerebral compromise.
Q5: A patient in the Post-Anesthesia Care Unit (PACU) reports "I feel like I'm burning
up." The nurse observes muscle rigidity in the jaw and chest, and the end-tidal CO2 is
rising. The nurse suspects malignant hyperthermia. What is the first action the nurse
should take?
A. Administer dantrolene sodium IV immediately.
B. Call the surgeon to the bedside to inform them of the complication.
C. Stop the anesthetic agents and hyperventilate with 100% oxygen.
D. Cover the patient with ice packs and apply cooling blankets.
, Correct Answer: C
Rationale: This choice is correct because the immediate management of malignant
hyperthermia involves stopping the triggering agents (inhaled
anesthetics/succinylcholine) and hyperventilating with 100% oxygen to reduce
hypercarbia. Dantrolene is the specific antidote but must be prepared and given after
the initial emergency response is initiated.
Q6: The nurse is caring for a postoperative patient who is refusing to cough and deep
breathe due to incisional pain. Which intervention is the most effective way to manage
this situation?
A. Tell the patient that if they do not cough, they will get pneumonia and stay in the
hospital longer.
B. Administer prescribed analgesic medication 30 minutes before prompting coughing
and deep breathing exercises.
C. Splint the incision with a pillow but do not force the coughing if the patient is in too
much pain.
D. Document the patient's refusal and attempt again in 4 hours.
Correct Answer: B
Rationale: This choice is correct because pre-emptive pain management is essential for
effective postoperative recovery activities; administering medication 30 minutes prior
allows the peak effect to coincide with the exercises, reducing pain and improving
participation. While splinting is helpful, it is not a substitute for adequate analgesia, and
simply documenting the refusal neglects the patient's need for pulmonary hygiene.
Q7: Which patient in the postoperative unit is at the highest risk for the development of
a deep vein thrombosis (DVT)?
A. A 25-year-old who had an appendectomy and is ambulating in the hall.
B. A 45-year-old who had a laparoscopic cholecystectomy and is scheduled for
discharge today.
C. A 68-year-old who had a total knee replacement and has not yet ambulated post-op
day 1.
D. A 50-year-old who had a hernia repair and is using sequential compression devices
(SCDs).
Correct Answer: C
Rationale: This choice is correct because Virchow's triad of stasis (immobility),
hypercoagulability (surgery), and venous endothelial injury is most prominent in an
elderly patient undergoing major orthopedic surgery like total knee replacement,
especially when delayed ambulation is present. Appendectomy and laparoscopic
procedures carry lower risks, and the use of SCDs in the hernia patient provides active
prophylaxis.
II Exam 1 Actual Exam 2026/2027
Fortis College Complete
Questions & Detailed Rationales -
Pass Guaranteed - A+ Graded
Perioperative Nursing & Surgical Complications – 10 questions
Q1: The nurse is preparing a patient for surgery scheduled for 0800. The patient takes
warfarin (Coumadin) daily for atrial fibrillation. What is the most important question the
nurse should ask the patient during the preoperative assessment?
A. "Do you have any allergies to latex or iodine?"
B. "When was the last time you took your warfarin?"
C. "Have you had anything to eat or drink since midnight?"
D. "Are you experiencing any chest pain or palpitations?"
Correct Answer: B
Rationale: This choice is correct because anticoagulants like warfarin significantly
increase the risk of intraoperative and postoperative bleeding. The nurse must
determine when the last dose was taken to assess if the patient's INR is safe for
surgery, as the provider typically holds warfarin several days prior. While allergies, NPO
status, and cardiac symptoms are important, managing the bleeding risk is the
immediate priority for a patient on anticoagulants.
Q2: During the preoperative teaching session, the nurse is instructing the patient on the
use of an incentive spirometer. Which statement by the patient indicates a need for
further teaching?
A. "I should place the mouthpiece in my mouth and seal my lips tightly around it."
B. "I need to breathe in slowly and deeply to try to get the piston to rise to the goal
marker."
C. "I will perform this exercise every hour while I am awake."
D. "I should exhale quickly into the device to make the ball go up as high as possible."
Correct Answer: D
,Rationale: This choice is correct because the incentive spirometer requires slow, deep
inhalation to sustain lung expansion and prevent atelectasis; exhaling quickly into the
device is incorrect technique and will not achieve the desired therapeutic effect. The
other statements reflect proper use of the device, including creating a seal, slow
inhalation, and frequency of use.
Q3: The circulating nurse in the operating room is responsible for which of the following
primary duties?
A. Passing sterile instruments to the surgeon.
B. Managing the surgical draping of the patient.
C. Coordinating the overall care of the patient in the OR and maintaining a safe
environment.
D. Administering general anesthesia and monitoring the patient's airway.
Correct Answer: C
Rationale: This choice is correct because the circulating nurse is a non-sterile role
responsible for managing the overall nursing care in the OR, documenting, checking
safety protocols, and coordinating the team. Passing instruments is the scrub nurse's
role, and administering anesthesia is the anesthesiologist or CRNA's responsibility.
Q4: A patient returns to the surgical unit following a total hip arthroplasty. The nurse
assesses the patient and finds the vital signs are BP 85/55 mmHg, HR 120 bpm, RR 24
bpm, and SpO2 90% on room air. The surgical dressing is dry and intact. What is the
nurse's priority action?
A. Elevate the lower extremities and apply warm blankets.
B. Increase the IV fluid rate to 200 mL/hr and reassess in 15 minutes.
C. Administer the prescribed PRN pain medication.
D. Check the patient's oxygen saturation with a pulse oximeter and apply oxygen.
Correct Answer: D
Rationale: This choice is correct because hypoxia (SpO2 90%) is a critical threat to life
and must be addressed immediately using the ABC (Airway, Breathing, Circulation)
framework. While hypotension and tachycardia suggest possible hypovolemia or shock,
correcting hypoxia takes precedence to prevent further cardiac or cerebral compromise.
Q5: A patient in the Post-Anesthesia Care Unit (PACU) reports "I feel like I'm burning
up." The nurse observes muscle rigidity in the jaw and chest, and the end-tidal CO2 is
rising. The nurse suspects malignant hyperthermia. What is the first action the nurse
should take?
A. Administer dantrolene sodium IV immediately.
B. Call the surgeon to the bedside to inform them of the complication.
C. Stop the anesthetic agents and hyperventilate with 100% oxygen.
D. Cover the patient with ice packs and apply cooling blankets.
, Correct Answer: C
Rationale: This choice is correct because the immediate management of malignant
hyperthermia involves stopping the triggering agents (inhaled
anesthetics/succinylcholine) and hyperventilating with 100% oxygen to reduce
hypercarbia. Dantrolene is the specific antidote but must be prepared and given after
the initial emergency response is initiated.
Q6: The nurse is caring for a postoperative patient who is refusing to cough and deep
breathe due to incisional pain. Which intervention is the most effective way to manage
this situation?
A. Tell the patient that if they do not cough, they will get pneumonia and stay in the
hospital longer.
B. Administer prescribed analgesic medication 30 minutes before prompting coughing
and deep breathing exercises.
C. Splint the incision with a pillow but do not force the coughing if the patient is in too
much pain.
D. Document the patient's refusal and attempt again in 4 hours.
Correct Answer: B
Rationale: This choice is correct because pre-emptive pain management is essential for
effective postoperative recovery activities; administering medication 30 minutes prior
allows the peak effect to coincide with the exercises, reducing pain and improving
participation. While splinting is helpful, it is not a substitute for adequate analgesia, and
simply documenting the refusal neglects the patient's need for pulmonary hygiene.
Q7: Which patient in the postoperative unit is at the highest risk for the development of
a deep vein thrombosis (DVT)?
A. A 25-year-old who had an appendectomy and is ambulating in the hall.
B. A 45-year-old who had a laparoscopic cholecystectomy and is scheduled for
discharge today.
C. A 68-year-old who had a total knee replacement and has not yet ambulated post-op
day 1.
D. A 50-year-old who had a hernia repair and is using sequential compression devices
(SCDs).
Correct Answer: C
Rationale: This choice is correct because Virchow's triad of stasis (immobility),
hypercoagulability (surgery), and venous endothelial injury is most prominent in an
elderly patient undergoing major orthopedic surgery like total knee replacement,
especially when delayed ambulation is present. Appendectomy and laparoscopic
procedures carry lower risks, and the use of SCDs in the hernia patient provides active
prophylaxis.
