NUR 254 Exam 1 Guide Galen College of
Nursing ACTUAL EXAM 2026/2027 | Galen
NUR 254 Exam 1 Guide | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1 – Perioperative Nursing (Questions 1–15)
Q1: A patient is scheduled for elective surgery and takes warfarin daily for atrial fibrillation. The nurse
should expect the provider to order which action regarding the warfarin?
A. Continue warfarin as usual
B. Increase the warfarin dose 3 days before surgery
C. Hold warfarin approximately 5 days before surgery [CORRECT]
D. Substitute warfarin with aspirin 1 week before surgery
Correct Answer: C
Rationale: Warfarin is typically held 5 days pre-operatively to allow INR to decrease to a safe level (INR <
1.5) and reduce bleeding risk during surgery.
Q2: A patient in the PACU after abdominal surgery has an oxygen saturation of 88% on room air. What is
the nurse's priority action?
A. Increase the IV fluid rate
B. Apply supplemental oxygen [CORRECT]
C. Administer pain medication
D. Reposition the patient
Correct Answer: B
Rationale: Oxygen saturation below 90% indicates hypoxemia; applying supplemental oxygen is the
priority to correct hypoxemia and prevent further complications.
Q3: A patient scheduled for surgery takes metformin 1000 mg twice daily for type 2 diabetes. The nurse
should instruct the patient to hold the metformin when?
,A. The morning of surgery only
B. 48 hours before surgery [CORRECT]
C. 1 week before surgery
D. Continue metformin until the day of surgery
Correct Answer: B
Rationale: Metformin should be held 48 hours prior to surgery to reduce the risk of lactic acidosis,
especially if contrast dye or hemodynamic instability is anticipated.
Q4: A nurse is reviewing pre-operative medications. Which medication should the nurse identify as
requiring special consideration and possible discontinuation before surgery?
A. Lisinopril
B. Aspirin [CORRECT]
C. Levothyroxine
D. Atorvastatin
Correct Answer: B
Rationale: Aspirin and other antiplatelet agents increase bleeding risk and typically require provider
evaluation for discontinuation 5–7 days before elective surgery.
Q5: A patient in the PACU after general anesthesia is not yet awake and is making gurgling sounds. What
is the nurse's priority intervention?
A. Insert an oropharyngeal airway
B. Suction the oropharynx [CORRECT]
C. Administer naloxone
D. Increase the oxygen flow rate
Correct Answer: B
Rationale: Gurgling sounds indicate secretions in the airway; suctioning is the priority to maintain a
patent airway and prevent aspiration.
Q6: During surgery, the patient develops tachycardia (HR 140 bpm), hyperthermia (105°F), muscle
rigidity, and hypercapnia. The nurse recognizes these as signs of which complication?
A. Anaphylaxis
, B. Malignant hyperthermia [CORRECT]
C. Thyroid storm
D. Neuroleptic malignant syndrome
Correct Answer: B
Rationale: Malignant hyperthermia is characterized by hyperthermia, tachycardia, muscle rigidity, and
hypercapnia triggered by volatile anesthetics or succinylcholine; immediate treatment with dantrolene
is required.
Q7: A post-operative patient on day 2 after knee replacement reports sudden chest pain and shortness
of breath. The nurse notes tachypnea and tachycardia. What is the nurse's priority action?
A. Administer pain medication
B. Apply oxygen and notify the provider immediately [CORRECT]
C. Encourage deep breathing exercises
D. Elevate the leg
Correct Answer: B
Rationale: Sudden chest pain, dyspnea, tachypnea, and tachycardia after surgery are classic signs of
pulmonary embolism; oxygen and immediate provider notification are priorities.
Q8: A patient is 8 hours post-op after abdominal surgery and has not yet passed flatus. The abdomen is
distended and tympanic. The nurse should suspect which complication?
A. Paralytic ileus [CORRECT]
B. Wound dehiscence
C. Peritonitis
D. Hemorrhage
Correct Answer: A
Rationale: Absence of bowel sounds, abdominal distension, and failure to pass flatus post-operatively
indicate paralytic ileus due to temporary bowel dysfunction from anesthesia and manipulation.
Q9: A nurse is caring for a post-operative patient on day 3. The patient has calf pain, warmth, and
swelling. Which complication should the nurse suspect?
A. Cellulitis
Nursing ACTUAL EXAM 2026/2027 | Galen
NUR 254 Exam 1 Guide | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1 – Perioperative Nursing (Questions 1–15)
Q1: A patient is scheduled for elective surgery and takes warfarin daily for atrial fibrillation. The nurse
should expect the provider to order which action regarding the warfarin?
A. Continue warfarin as usual
B. Increase the warfarin dose 3 days before surgery
C. Hold warfarin approximately 5 days before surgery [CORRECT]
D. Substitute warfarin with aspirin 1 week before surgery
Correct Answer: C
Rationale: Warfarin is typically held 5 days pre-operatively to allow INR to decrease to a safe level (INR <
1.5) and reduce bleeding risk during surgery.
Q2: A patient in the PACU after abdominal surgery has an oxygen saturation of 88% on room air. What is
the nurse's priority action?
A. Increase the IV fluid rate
B. Apply supplemental oxygen [CORRECT]
C. Administer pain medication
D. Reposition the patient
Correct Answer: B
Rationale: Oxygen saturation below 90% indicates hypoxemia; applying supplemental oxygen is the
priority to correct hypoxemia and prevent further complications.
Q3: A patient scheduled for surgery takes metformin 1000 mg twice daily for type 2 diabetes. The nurse
should instruct the patient to hold the metformin when?
,A. The morning of surgery only
B. 48 hours before surgery [CORRECT]
C. 1 week before surgery
D. Continue metformin until the day of surgery
Correct Answer: B
Rationale: Metformin should be held 48 hours prior to surgery to reduce the risk of lactic acidosis,
especially if contrast dye or hemodynamic instability is anticipated.
Q4: A nurse is reviewing pre-operative medications. Which medication should the nurse identify as
requiring special consideration and possible discontinuation before surgery?
A. Lisinopril
B. Aspirin [CORRECT]
C. Levothyroxine
D. Atorvastatin
Correct Answer: B
Rationale: Aspirin and other antiplatelet agents increase bleeding risk and typically require provider
evaluation for discontinuation 5–7 days before elective surgery.
Q5: A patient in the PACU after general anesthesia is not yet awake and is making gurgling sounds. What
is the nurse's priority intervention?
A. Insert an oropharyngeal airway
B. Suction the oropharynx [CORRECT]
C. Administer naloxone
D. Increase the oxygen flow rate
Correct Answer: B
Rationale: Gurgling sounds indicate secretions in the airway; suctioning is the priority to maintain a
patent airway and prevent aspiration.
Q6: During surgery, the patient develops tachycardia (HR 140 bpm), hyperthermia (105°F), muscle
rigidity, and hypercapnia. The nurse recognizes these as signs of which complication?
A. Anaphylaxis
, B. Malignant hyperthermia [CORRECT]
C. Thyroid storm
D. Neuroleptic malignant syndrome
Correct Answer: B
Rationale: Malignant hyperthermia is characterized by hyperthermia, tachycardia, muscle rigidity, and
hypercapnia triggered by volatile anesthetics or succinylcholine; immediate treatment with dantrolene
is required.
Q7: A post-operative patient on day 2 after knee replacement reports sudden chest pain and shortness
of breath. The nurse notes tachypnea and tachycardia. What is the nurse's priority action?
A. Administer pain medication
B. Apply oxygen and notify the provider immediately [CORRECT]
C. Encourage deep breathing exercises
D. Elevate the leg
Correct Answer: B
Rationale: Sudden chest pain, dyspnea, tachypnea, and tachycardia after surgery are classic signs of
pulmonary embolism; oxygen and immediate provider notification are priorities.
Q8: A patient is 8 hours post-op after abdominal surgery and has not yet passed flatus. The abdomen is
distended and tympanic. The nurse should suspect which complication?
A. Paralytic ileus [CORRECT]
B. Wound dehiscence
C. Peritonitis
D. Hemorrhage
Correct Answer: A
Rationale: Absence of bowel sounds, abdominal distension, and failure to pass flatus post-operatively
indicate paralytic ileus due to temporary bowel dysfunction from anesthesia and manipulation.
Q9: A nurse is caring for a post-operative patient on day 3. The patient has calf pain, warmth, and
swelling. Which complication should the nurse suspect?
A. Cellulitis
