ONDROS NUR 163 FINAL
H
EXAM 2025-2026 | Complete
Review Guide with Verified
Answers | Adult Health & Elderly
Nursing Care | Pass Guaranteed
- A+ Graded
## **PART A: MULTIPLE CHOICE (Q1–Q75)**
* *Q1 (Perioperative – NPO):** A patient is scheduled for a laparoscopic cholecystectomy at 8:00
AM. The nurse notes that the patient ate a piece of toast at 3:00 AM. What is the most
appropriate action?
. Cancel the surgery and reschedule for another day.
A
B. Notify the surgeon or anesthesia provider immediately.
C. Document the intake and proceed because it was >4 hours prior.
D. Administer IV metoclopramide to accelerate gastric emptying.
**[CORRECT]** B
* Rationale: Current (2022) NPO guidelines require solid foods be withheld for 6–8 hours before
elective surgery. Eating at 3:00 AM (5 hours before) violates this. The anesthesia provider must
assess aspiration risk. Distractor C is unsafe; D is not a nursing intervention to override NPO
without orders.*
---
,* *Q2 (Perioperative – Informed Consent):** A 68-year-old patient is scheduled for a total knee
replacement. The patient asks the nurse to explain the risks of the surgery. What is the nurse's
best response?
. "I will have the surgeon come and discuss the risks with you."
A
B. "The risks include infection, bleeding, and blood clots."
C. "The surgeon is legally responsible to explain all risks to you."
D. "Let me get the consent form so you can read the risks yourself."
**[CORRECT]** A
* Rationale: Informed consent is the legal responsibility of the surgeon performing the procedure.
The nurse witnesses the signature and ensures the patient understands, but does not explain
surgical risks. Distractor B involves the nurse providing medical information outside their scope.*
---
* *Q3 (Perioperative – Medication Withholding):** A patient taking warfarin is scheduled for
surgery in 5 days. Which action by the nurse is most appropriate?
. Instruct the patient to continue warfarin until the day of surgery.
A
B. Advise the patient to stop warfarin immediately and contact the surgeon.
C. Confirm with the surgeon about holding warfarin and bridging with heparin.
D. Tell the patient to take half the usual dose until surgery.
**[CORRECT]** C
* Rationale: Warfarin is typically held 5 days before surgery to reduce bleeding risk, often with
bridging anticoagulation. The nurse must verify the surgeon's specific orders rather than
independently directing medication changes. Distractor A increases bleeding risk; B and D
involve the nurse making independent medication decisions.*
---
* *Q4 (Perioperative – Positioning):** During a lengthy abdominal surgery, the patient is placed in
Trendelenburg position. Which complication is the nurse most concerned about?
. Brachial plexus injury
A
B. Pressure injury to the sacrum
C. Venous air embolism
D. Respiratory compromise
**[CORRECT]** A
,* Rationale: Trendelenburg position with arms extended on arm boards can cause brachial
plexus stretch injury due to shoulder hyperextension and downward traction. The nurse ensures
proper arm positioning with padding. Distractor D is a concern but less specific; B is more
common in supine; C is associated with sitting positions.*
---
* *Q5 (Perioperative – Postoperative):** On postoperative day 1 after abdominal surgery, a
patient reports severe incisional pain rated 8/10. The patient is reluctant to ambulate. What is
the nurse's priority intervention?
. Administer prescribed analgesic 30 minutes before ambulation.
A
B. Explain that ambulation will reduce pain over time.
C. Document the patient's refusal to ambulate.
D. Encourage deep breathing exercises instead.
**[CORRECT]** A
* Rationale: Pain is a barrier to early ambulation, which is critical for preventing DVT, atelectasis,
and ileus. Pre-medicating with analgesics allows effective pain control prior to activity. Distractor
B minimizes the patient's pain; C is passive; D substitutes one intervention without addressing
the barrier.*
---
* *Q6 (Perioperative – DVT Prevention):** Which nursing intervention is most effective in
preventing postoperative deep vein thrombosis (DVT)?
. Applying thigh-high compression stockings
A
B. Administering prophylactic low-molecular-weight heparin
C. Encouraging early ambulation and leg exercises
D. Maintaining the patient on bed rest for 48 hours
**[CORRECT]** C
* Rationale: Early ambulation and leg exercises promote venous return and are foundational
DVT prevention strategies. Distractor D is contraindicated; A and B are adjunctive measures but
C is the most effective nursing intervention the nurse can independently implement.*
---
, * *Q7 (Perioperative – Respiratory Complications):** A postoperative patient develops sudden
dyspnea, tachypnea, and pleuritic chest pain 3 days after hip replacement. What is the nurse's
priority action?
. Administer prescribed oxygen and notify the provider immediately.
A
B. Encourage deep breathing and incentive spirometry.
C. Position the patient in high-Fowler's and reassess in 15 minutes.
D. Obtain a stat chest x-ray before contacting the provider.
**[CORRECT]** A
* Rationale: These symptoms are classic for pulmonary embolism, a life-threatening
postoperative complication. Immediate oxygen administration and provider notification are
priorities. Distractor B is appropriate for atelectasis but not acute PE; C delays critical
intervention; D delays provider notification.*
---
* *Q8 (Perioperative – Fever Assessment):** On postoperative day 2, a patient's temperature
rises to 38.5°C (101.3°F). Which assessment finding best differentiates atelectasis from wound
infection as the cause?
. Presence of productive cough with yellow sputum
A
B. Diminished breath sounds in the lung bases
C. Wound erythema and purulent drainage
D. Tachycardia and mild hypotension
**[CORRECT]** C
* Rationale: Wound infection is characterized by localized signs including erythema, warmth,
swelling, and purulent drainage. Atelectasis typically presents with diminished breath sounds
without purulent wound findings. Distractor A could indicate pneumonia; B is nonspecific; D
suggests sepsis.*
---
* *Q9 (Fluid & Electrolytes – Dehydration):** A 78-year-old patient has diarrhea for 3 days and
presents with dry mucous membranes, orthostatic hypotension, and decreased skin turgor.
Which type of dehydration is most likely?
. Isotonic dehydration
A
B. Hypotonic dehydration
C. Hypertonic dehydration
D. Normotonic dehydration
H
EXAM 2025-2026 | Complete
Review Guide with Verified
Answers | Adult Health & Elderly
Nursing Care | Pass Guaranteed
- A+ Graded
## **PART A: MULTIPLE CHOICE (Q1–Q75)**
* *Q1 (Perioperative – NPO):** A patient is scheduled for a laparoscopic cholecystectomy at 8:00
AM. The nurse notes that the patient ate a piece of toast at 3:00 AM. What is the most
appropriate action?
. Cancel the surgery and reschedule for another day.
A
B. Notify the surgeon or anesthesia provider immediately.
C. Document the intake and proceed because it was >4 hours prior.
D. Administer IV metoclopramide to accelerate gastric emptying.
**[CORRECT]** B
* Rationale: Current (2022) NPO guidelines require solid foods be withheld for 6–8 hours before
elective surgery. Eating at 3:00 AM (5 hours before) violates this. The anesthesia provider must
assess aspiration risk. Distractor C is unsafe; D is not a nursing intervention to override NPO
without orders.*
---
,* *Q2 (Perioperative – Informed Consent):** A 68-year-old patient is scheduled for a total knee
replacement. The patient asks the nurse to explain the risks of the surgery. What is the nurse's
best response?
. "I will have the surgeon come and discuss the risks with you."
A
B. "The risks include infection, bleeding, and blood clots."
C. "The surgeon is legally responsible to explain all risks to you."
D. "Let me get the consent form so you can read the risks yourself."
**[CORRECT]** A
* Rationale: Informed consent is the legal responsibility of the surgeon performing the procedure.
The nurse witnesses the signature and ensures the patient understands, but does not explain
surgical risks. Distractor B involves the nurse providing medical information outside their scope.*
---
* *Q3 (Perioperative – Medication Withholding):** A patient taking warfarin is scheduled for
surgery in 5 days. Which action by the nurse is most appropriate?
. Instruct the patient to continue warfarin until the day of surgery.
A
B. Advise the patient to stop warfarin immediately and contact the surgeon.
C. Confirm with the surgeon about holding warfarin and bridging with heparin.
D. Tell the patient to take half the usual dose until surgery.
**[CORRECT]** C
* Rationale: Warfarin is typically held 5 days before surgery to reduce bleeding risk, often with
bridging anticoagulation. The nurse must verify the surgeon's specific orders rather than
independently directing medication changes. Distractor A increases bleeding risk; B and D
involve the nurse making independent medication decisions.*
---
* *Q4 (Perioperative – Positioning):** During a lengthy abdominal surgery, the patient is placed in
Trendelenburg position. Which complication is the nurse most concerned about?
. Brachial plexus injury
A
B. Pressure injury to the sacrum
C. Venous air embolism
D. Respiratory compromise
**[CORRECT]** A
,* Rationale: Trendelenburg position with arms extended on arm boards can cause brachial
plexus stretch injury due to shoulder hyperextension and downward traction. The nurse ensures
proper arm positioning with padding. Distractor D is a concern but less specific; B is more
common in supine; C is associated with sitting positions.*
---
* *Q5 (Perioperative – Postoperative):** On postoperative day 1 after abdominal surgery, a
patient reports severe incisional pain rated 8/10. The patient is reluctant to ambulate. What is
the nurse's priority intervention?
. Administer prescribed analgesic 30 minutes before ambulation.
A
B. Explain that ambulation will reduce pain over time.
C. Document the patient's refusal to ambulate.
D. Encourage deep breathing exercises instead.
**[CORRECT]** A
* Rationale: Pain is a barrier to early ambulation, which is critical for preventing DVT, atelectasis,
and ileus. Pre-medicating with analgesics allows effective pain control prior to activity. Distractor
B minimizes the patient's pain; C is passive; D substitutes one intervention without addressing
the barrier.*
---
* *Q6 (Perioperative – DVT Prevention):** Which nursing intervention is most effective in
preventing postoperative deep vein thrombosis (DVT)?
. Applying thigh-high compression stockings
A
B. Administering prophylactic low-molecular-weight heparin
C. Encouraging early ambulation and leg exercises
D. Maintaining the patient on bed rest for 48 hours
**[CORRECT]** C
* Rationale: Early ambulation and leg exercises promote venous return and are foundational
DVT prevention strategies. Distractor D is contraindicated; A and B are adjunctive measures but
C is the most effective nursing intervention the nurse can independently implement.*
---
, * *Q7 (Perioperative – Respiratory Complications):** A postoperative patient develops sudden
dyspnea, tachypnea, and pleuritic chest pain 3 days after hip replacement. What is the nurse's
priority action?
. Administer prescribed oxygen and notify the provider immediately.
A
B. Encourage deep breathing and incentive spirometry.
C. Position the patient in high-Fowler's and reassess in 15 minutes.
D. Obtain a stat chest x-ray before contacting the provider.
**[CORRECT]** A
* Rationale: These symptoms are classic for pulmonary embolism, a life-threatening
postoperative complication. Immediate oxygen administration and provider notification are
priorities. Distractor B is appropriate for atelectasis but not acute PE; C delays critical
intervention; D delays provider notification.*
---
* *Q8 (Perioperative – Fever Assessment):** On postoperative day 2, a patient's temperature
rises to 38.5°C (101.3°F). Which assessment finding best differentiates atelectasis from wound
infection as the cause?
. Presence of productive cough with yellow sputum
A
B. Diminished breath sounds in the lung bases
C. Wound erythema and purulent drainage
D. Tachycardia and mild hypotension
**[CORRECT]** C
* Rationale: Wound infection is characterized by localized signs including erythema, warmth,
swelling, and purulent drainage. Atelectasis typically presents with diminished breath sounds
without purulent wound findings. Distractor A could indicate pneumonia; B is nonspecific; D
suggests sepsis.*
---
* *Q9 (Fluid & Electrolytes – Dehydration):** A 78-year-old patient has diarrhea for 3 days and
presents with dry mucous membranes, orthostatic hypotension, and decreased skin turgor.
Which type of dehydration is most likely?
. Isotonic dehydration
A
B. Hypotonic dehydration
C. Hypertonic dehydration
D. Normotonic dehydration
