ONDROS NUR 163 FINAL EXAM
H
2025-2026 | Complete Guide with
Verified Q&A | Adult Health &
Elderly Patient Care | Pass
Guaranteed - A+ Graded
## **PART A: MULTIPLE CHOICE (Questions 1–75)**
* *Q1 (Perioperative – NPO Guidelines):** A patient is scheduled for a laparoscopic
cholecystectomy at 0800. The nurse notes the patient ate a piece of toast at 0300. 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: Per ASA 2011/2022 guidelines, solid foods require 6–8 hours NPO before elective
surgery to reduce aspiration risk; toast at 0300 is only 5 hours before 0800. The anesthesia
provider must assess aspiration risk and determine if delay is needed. Distractor C is dangerous
because 5 hours is insufficient for solid food emptying. Test-taking tip: Never independently
cancel surgery—always notify the provider and let them make the clinical decision.*
---
* *Q2 (Perioperative – Informed Consent):** A 78-year-old patient with mild dementia is
scheduled for a total hip replacement. The patient's daughter, who holds medical power of
attorney, is present. Who must sign the surgical consent form?
. The patient alone, as he can verbally agree
A
B. The daughter with medical power of attorney
C. Both the patient and the daughter together
,D. The surgeon, as the patient lacks capacity
* *[CORRECT]** B
*Rationale: When a patient lacks decision-making capacity, the legally designated healthcare
proxy (medical power of attorney) provides informed consent on the patient's behalf; this is both
an ethical and legal requirement. Distractor A is incorrect because mild dementia may impair the
ability to understand risks/benefits sufficiently for informed consent. Clinical pearl: Always verify
the POA document is current and specific to healthcare decisions before accepting consent.*
---
* *Q3 (Perioperative – Medication Withholding):** A patient takes warfarin 5 mg daily for atrial
fibrillation and is scheduled for elective knee arthroscopy in 5 days. What is the nurse's priority
action?
. Instruct the patient to continue warfarin until the day of surgery
A
B. Instruct the patient to stop warfarin 3–5 days before surgery and contact the surgeon
C. Tell the patient to double the dose the night before for "blood thinning"
D. Advise the patient to switch to aspirin 81 mg until surgery
* *[CORRECT]** B
*Rationale: Warfarin requires discontinuation 3–5 days preoperatively to allow INR to normalize
(<1.5) and reduce bleeding risk; the surgeon/anesthesiologist must coordinate this plan.
Distractor A risks intraoperative hemorrhage; D is unsafe without provider orders. Test-taking
tip: Never instruct patients to independently stop or change anticoagulants—always verify with
the prescribing provider and surgeon.*
---
* *Q4 (Perioperative – Sterile Technique):** During a sterile dressing change, the nurse
accidentally touches the sterile field with an ungloved hand. What is the correct action?
. Continue the procedure if the touch was brief
A
B. Remove the contaminated item and continue with the remaining sterile supplies
C. Discard all contaminated supplies, rewash hands, and set up a new sterile field
D. Apply alcohol-based hand rub and continue
* *[CORRECT]** C
*Rationale: Any break in sterile technique requires complete replacement of the sterile field and
supplies to prevent surgical site infection; this is a non-negotiable principle of asepsis. Distractor
B is incorrect because the entire field is considered contaminated once breached. Clinical pearl:
When in doubt, throw it out—restarting is always safer than risking infection.*
---
,* *Q5 (Perioperative – Positioning Complications):** A patient is in lithotomy position for 2.5
hours during a gynecologic procedure. Postoperatively, the nurse notes numbness and tingling
in the patient's lower legs. What complication should the nurse suspect?
. Compartment syndrome
A
B. Peroneal nerve injury
C. Deep vein thrombosis
D. Arterial occlusion
* *[CORRECT]** B
*Rationale: Lithotomy position places pressure on the peroneal nerve at the fibular head,
causing neuropraxia manifesting as foot drop, numbness, or tingling in the lower extremity.
Distractor A typically presents with severe pain and tense compartments, not isolated
numbness. Test-taking tip: Match the position to the nerve at risk—lithotomy = peroneal nerve;
supine with arms abducted = brachial plexus.*
---
* *Q6 (Perioperative – Postoperative Fever):** On postoperative day 2, a patient develops a
temperature of 38.6°C (101.5°F). According to the "5 W's" of postoperative fever, what is the
most likely cause at this time frame?
. Wind (pneumonia/atelectasis)
A
B. Water (urinary tract infection)
C. Wound (surgical site infection)
D. Walking (DVT/PE)
* *[CORRECT]** A
*Rationale: The classic "5 W's" mnemonic places atelectasis/pneumonia (Wind) at POD 1–2
due to anesthesia effects, shallow breathing, and immobility; this is the most common early
postoperative fever cause. Distractor C (wound infection) typically appears POD 5–7. Clinical
pearl: POD 1–2 = Wind; POD 3–5 = Water (UTI); POD 5–7 = Wound; POD 7+ = Walking (DVT)
or Wonder drugs (drug fever).*
---
* *Q7 (Perioperative – DVT Prevention):** Which intervention is most effective for preventing
postoperative deep vein thrombosis?
. Early ambulation within 24 hours of surgery
A
B. Application of TED hose only
C. Bed rest with passive range of motion
D. Daily aspirin 325 mg
, * *[CORRECT]** A
*Rationale: Early ambulation is the single most effective non-pharmacologic intervention for DVT
prevention because it promotes venous return through calf muscle pump action and reduces
venous stasis. Distractor B (TED hose) is adjunctive and insufficient alone; D (aspirin) is not
first-line prophylaxis for postoperative DVT. Test-taking tip: When prioritizing DVT prevention,
ambulation always outranks passive interventions.*
---
* *Q8 (Perioperative – Respiratory Complications):** A postoperative patient has shallow
respirations at 18/min, SpO2 92% on room air, and diminished breath sounds in the bases.
What is the nurse's priority intervention?
. Administer prescribed opioid analgesic
A
B. Encourage deep breathing and coughing exercises
C. Place the patient in high Fowler's position and call the provider
D. Apply supplemental oxygen at 2 L/min via nasal cannula
* *[CORRECT]** B
*Rationale: Shallow breathing with basilar diminished sounds indicates atelectasis; deep
breathing and coughing (incentive spirometry) are first-line nursing interventions to re-expand
alveoli and prevent pneumonia. Distractor A would further depress respirations; while D may be
needed, B addresses the root cause. Clinical pearl: Always treat the cause before the
symptom—atelectasis requires lung expansion, not just oxygen.*
---
* *Q9 (Fluid & Electrolytes – Dehydration):** A 72-year-old patient has had vomiting and diarrhea
for 3 days. Assessment reveals dry mucous membranes, decreased skin turgor, orthostatic
hypotension, and urine specific gravity of 1.030. What type of dehydration is most likely?
. Isotonic dehydration
A
B. Hypotonic dehydration
C. Hypertonic dehydration
D. Third-spacing
* *[CORRECT]** A
*Rationale: Isotonic dehydration (loss of water and electrolytes in proportion, serum Na+
135–145 mEq/L) is the most common type from GI losses and presents with orthostatic
hypotension and normal/high urine specific gravity. Distractor C (hypertonic) would show
elevated serum sodium and altered mental status. Test-taking tip: GI fluid losses typically cause
isotonic dehydration; pure water deprivation causes hypertonic.*
H
2025-2026 | Complete Guide with
Verified Q&A | Adult Health &
Elderly Patient Care | Pass
Guaranteed - A+ Graded
## **PART A: MULTIPLE CHOICE (Questions 1–75)**
* *Q1 (Perioperative – NPO Guidelines):** A patient is scheduled for a laparoscopic
cholecystectomy at 0800. The nurse notes the patient ate a piece of toast at 0300. 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: Per ASA 2011/2022 guidelines, solid foods require 6–8 hours NPO before elective
surgery to reduce aspiration risk; toast at 0300 is only 5 hours before 0800. The anesthesia
provider must assess aspiration risk and determine if delay is needed. Distractor C is dangerous
because 5 hours is insufficient for solid food emptying. Test-taking tip: Never independently
cancel surgery—always notify the provider and let them make the clinical decision.*
---
* *Q2 (Perioperative – Informed Consent):** A 78-year-old patient with mild dementia is
scheduled for a total hip replacement. The patient's daughter, who holds medical power of
attorney, is present. Who must sign the surgical consent form?
. The patient alone, as he can verbally agree
A
B. The daughter with medical power of attorney
C. Both the patient and the daughter together
,D. The surgeon, as the patient lacks capacity
* *[CORRECT]** B
*Rationale: When a patient lacks decision-making capacity, the legally designated healthcare
proxy (medical power of attorney) provides informed consent on the patient's behalf; this is both
an ethical and legal requirement. Distractor A is incorrect because mild dementia may impair the
ability to understand risks/benefits sufficiently for informed consent. Clinical pearl: Always verify
the POA document is current and specific to healthcare decisions before accepting consent.*
---
* *Q3 (Perioperative – Medication Withholding):** A patient takes warfarin 5 mg daily for atrial
fibrillation and is scheduled for elective knee arthroscopy in 5 days. What is the nurse's priority
action?
. Instruct the patient to continue warfarin until the day of surgery
A
B. Instruct the patient to stop warfarin 3–5 days before surgery and contact the surgeon
C. Tell the patient to double the dose the night before for "blood thinning"
D. Advise the patient to switch to aspirin 81 mg until surgery
* *[CORRECT]** B
*Rationale: Warfarin requires discontinuation 3–5 days preoperatively to allow INR to normalize
(<1.5) and reduce bleeding risk; the surgeon/anesthesiologist must coordinate this plan.
Distractor A risks intraoperative hemorrhage; D is unsafe without provider orders. Test-taking
tip: Never instruct patients to independently stop or change anticoagulants—always verify with
the prescribing provider and surgeon.*
---
* *Q4 (Perioperative – Sterile Technique):** During a sterile dressing change, the nurse
accidentally touches the sterile field with an ungloved hand. What is the correct action?
. Continue the procedure if the touch was brief
A
B. Remove the contaminated item and continue with the remaining sterile supplies
C. Discard all contaminated supplies, rewash hands, and set up a new sterile field
D. Apply alcohol-based hand rub and continue
* *[CORRECT]** C
*Rationale: Any break in sterile technique requires complete replacement of the sterile field and
supplies to prevent surgical site infection; this is a non-negotiable principle of asepsis. Distractor
B is incorrect because the entire field is considered contaminated once breached. Clinical pearl:
When in doubt, throw it out—restarting is always safer than risking infection.*
---
,* *Q5 (Perioperative – Positioning Complications):** A patient is in lithotomy position for 2.5
hours during a gynecologic procedure. Postoperatively, the nurse notes numbness and tingling
in the patient's lower legs. What complication should the nurse suspect?
. Compartment syndrome
A
B. Peroneal nerve injury
C. Deep vein thrombosis
D. Arterial occlusion
* *[CORRECT]** B
*Rationale: Lithotomy position places pressure on the peroneal nerve at the fibular head,
causing neuropraxia manifesting as foot drop, numbness, or tingling in the lower extremity.
Distractor A typically presents with severe pain and tense compartments, not isolated
numbness. Test-taking tip: Match the position to the nerve at risk—lithotomy = peroneal nerve;
supine with arms abducted = brachial plexus.*
---
* *Q6 (Perioperative – Postoperative Fever):** On postoperative day 2, a patient develops a
temperature of 38.6°C (101.5°F). According to the "5 W's" of postoperative fever, what is the
most likely cause at this time frame?
. Wind (pneumonia/atelectasis)
A
B. Water (urinary tract infection)
C. Wound (surgical site infection)
D. Walking (DVT/PE)
* *[CORRECT]** A
*Rationale: The classic "5 W's" mnemonic places atelectasis/pneumonia (Wind) at POD 1–2
due to anesthesia effects, shallow breathing, and immobility; this is the most common early
postoperative fever cause. Distractor C (wound infection) typically appears POD 5–7. Clinical
pearl: POD 1–2 = Wind; POD 3–5 = Water (UTI); POD 5–7 = Wound; POD 7+ = Walking (DVT)
or Wonder drugs (drug fever).*
---
* *Q7 (Perioperative – DVT Prevention):** Which intervention is most effective for preventing
postoperative deep vein thrombosis?
. Early ambulation within 24 hours of surgery
A
B. Application of TED hose only
C. Bed rest with passive range of motion
D. Daily aspirin 325 mg
, * *[CORRECT]** A
*Rationale: Early ambulation is the single most effective non-pharmacologic intervention for DVT
prevention because it promotes venous return through calf muscle pump action and reduces
venous stasis. Distractor B (TED hose) is adjunctive and insufficient alone; D (aspirin) is not
first-line prophylaxis for postoperative DVT. Test-taking tip: When prioritizing DVT prevention,
ambulation always outranks passive interventions.*
---
* *Q8 (Perioperative – Respiratory Complications):** A postoperative patient has shallow
respirations at 18/min, SpO2 92% on room air, and diminished breath sounds in the bases.
What is the nurse's priority intervention?
. Administer prescribed opioid analgesic
A
B. Encourage deep breathing and coughing exercises
C. Place the patient in high Fowler's position and call the provider
D. Apply supplemental oxygen at 2 L/min via nasal cannula
* *[CORRECT]** B
*Rationale: Shallow breathing with basilar diminished sounds indicates atelectasis; deep
breathing and coughing (incentive spirometry) are first-line nursing interventions to re-expand
alveoli and prevent pneumonia. Distractor A would further depress respirations; while D may be
needed, B addresses the root cause. Clinical pearl: Always treat the cause before the
symptom—atelectasis requires lung expansion, not just oxygen.*
---
* *Q9 (Fluid & Electrolytes – Dehydration):** A 72-year-old patient has had vomiting and diarrhea
for 3 days. Assessment reveals dry mucous membranes, decreased skin turgor, orthostatic
hypotension, and urine specific gravity of 1.030. What type of dehydration is most likely?
. Isotonic dehydration
A
B. Hypotonic dehydration
C. Hypertonic dehydration
D. Third-spacing
* *[CORRECT]** A
*Rationale: Isotonic dehydration (loss of water and electrolytes in proportion, serum Na+
135–145 mEq/L) is the most common type from GI losses and presents with orthostatic
hypotension and normal/high urine specific gravity. Distractor C (hypertonic) would show
elevated serum sodium and altered mental status. Test-taking tip: GI fluid losses typically cause
isotonic dehydration; pure water deprivation causes hypertonic.*
