NURS 120: Introduction to Medical-Surgical Nursing - Week 14
Comprehensive Quiz 2026 |WCU
1. A nurse is monitoring a patient postoperatively who received general
anesthesia. Which finding is the earliest indicator of malignant hyperthermia?
A. Hyperthermia (temperature of 104°F)
B. Muscle rigidity
C. Tachypnea and sinus tachycardia
D. Hypokalemia
Answer: C
Rationale: Tachycardia and tachypnea are the earliest signs of malignant hyperthermia
due to increased metabolic rate. Fever is often a late sign.
2. In the preoperative phase, a patient identifies a history of latex allergy. Which
action is the nurse’s priority?
A. Document the allergy in the medical record
B. Ensure a latex-free environment in the OR
C. Notify the surgical team and the pharmacy
D. Check for cross-sensitivities to bananas or avocados
Answer: B
Rationale: While documentation and notification are important, the priority safety action
is ensuring the physical environment is latex-free to prevent anaphylaxis.
,3. A patient who underwent abdominal surgery 24 hours ago has not yet
voided. The nurse performs a bladder scan which shows 450 mL of urine. What
is the next nursing action?
A. Ambulate the patient to the bathroom
B. Encourage the patient to drink more fluids
C. Insert a permanent indwelling catheter
D. Notify the surgeon and request an order for intermittent catheterization
Answer: A
Rationale: Ambulation or sitting upright often helps facilitate voiding post-surgery.
Invasive measures like catheterization should follow if non-invasive methods fail.
4. A patient is diagnosed with Small Cell Lung Cancer (SCLC) and develops
Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which laboratory
value is most concerning?
A. Urine specific gravity of 1.010
B. Serum potassium of 5.2 mEq/L
C. BUN of 20 mg/dL
D. Serum sodium of 118 mEq/L
Answer: D
Rationale: SIADH causes water retention and dilutional hyponatremia. A sodium level of
118 mEq/L is critically low and puts the patient at risk for seizures and cerebral edema.
5. A nurse is caring for a patient receiving chemotherapy who has a neutrophil
count of 450/mm3. Which intervention is most critical?
A. Administering a stool softener
B. Avoiding all fresh flowers and raw fruits/vegetables in the room
C. Ensuring the patient wears a mask in the hallway
D. Applying heat to the IV site if redness occurs
Answer: B
, Rationale: A neutrophil count below 500/mm3 indicates severe neutropenia. Neutropenic
precautions include avoiding sources of bacteria such as fresh plants or unpeeled produce.
6. During a blood transfusion, the patient complains of chills and lower back
pain. What is the nurse’s first action?
A. Slow the infusion rate
B. Administer diphenhydramine
C. Check the patient’s temperature
D. Stop the transfusion immediately
Answer: D
Rationale: Chills and back pain suggest an acute hemolytic reaction. The first priority is to
stop the transfusion to prevent further exposure to the incompatible blood.
7. A patient with advanced cirrhosis presents with shifting dullness on
abdominal percussion and a distended abdomen. Which medication does the
nurse expect to administer to reduce portal hypertension?
A. Propranolol
B. Spironolactone
C. Lactulose
D. Vitamin K
Answer: A
Rationale: Non-selective beta-blockers like Propranolol are used to reduce portal pressure
and the risk of variceal bleeding.
Comprehensive Quiz 2026 |WCU
1. A nurse is monitoring a patient postoperatively who received general
anesthesia. Which finding is the earliest indicator of malignant hyperthermia?
A. Hyperthermia (temperature of 104°F)
B. Muscle rigidity
C. Tachypnea and sinus tachycardia
D. Hypokalemia
Answer: C
Rationale: Tachycardia and tachypnea are the earliest signs of malignant hyperthermia
due to increased metabolic rate. Fever is often a late sign.
2. In the preoperative phase, a patient identifies a history of latex allergy. Which
action is the nurse’s priority?
A. Document the allergy in the medical record
B. Ensure a latex-free environment in the OR
C. Notify the surgical team and the pharmacy
D. Check for cross-sensitivities to bananas or avocados
Answer: B
Rationale: While documentation and notification are important, the priority safety action
is ensuring the physical environment is latex-free to prevent anaphylaxis.
,3. A patient who underwent abdominal surgery 24 hours ago has not yet
voided. The nurse performs a bladder scan which shows 450 mL of urine. What
is the next nursing action?
A. Ambulate the patient to the bathroom
B. Encourage the patient to drink more fluids
C. Insert a permanent indwelling catheter
D. Notify the surgeon and request an order for intermittent catheterization
Answer: A
Rationale: Ambulation or sitting upright often helps facilitate voiding post-surgery.
Invasive measures like catheterization should follow if non-invasive methods fail.
4. A patient is diagnosed with Small Cell Lung Cancer (SCLC) and develops
Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which laboratory
value is most concerning?
A. Urine specific gravity of 1.010
B. Serum potassium of 5.2 mEq/L
C. BUN of 20 mg/dL
D. Serum sodium of 118 mEq/L
Answer: D
Rationale: SIADH causes water retention and dilutional hyponatremia. A sodium level of
118 mEq/L is critically low and puts the patient at risk for seizures and cerebral edema.
5. A nurse is caring for a patient receiving chemotherapy who has a neutrophil
count of 450/mm3. Which intervention is most critical?
A. Administering a stool softener
B. Avoiding all fresh flowers and raw fruits/vegetables in the room
C. Ensuring the patient wears a mask in the hallway
D. Applying heat to the IV site if redness occurs
Answer: B
, Rationale: A neutrophil count below 500/mm3 indicates severe neutropenia. Neutropenic
precautions include avoiding sources of bacteria such as fresh plants or unpeeled produce.
6. During a blood transfusion, the patient complains of chills and lower back
pain. What is the nurse’s first action?
A. Slow the infusion rate
B. Administer diphenhydramine
C. Check the patient’s temperature
D. Stop the transfusion immediately
Answer: D
Rationale: Chills and back pain suggest an acute hemolytic reaction. The first priority is to
stop the transfusion to prevent further exposure to the incompatible blood.
7. A patient with advanced cirrhosis presents with shifting dullness on
abdominal percussion and a distended abdomen. Which medication does the
nurse expect to administer to reduce portal hypertension?
A. Propranolol
B. Spironolactone
C. Lactulose
D. Vitamin K
Answer: A
Rationale: Non-selective beta-blockers like Propranolol are used to reduce portal pressure
and the risk of variceal bleeding.
