NUR 242 MEDICAL-SURGICAL NURSING
Actual Exam 2026/2027 Complete
Questions and Answers | 100% Verified
Detailed Rationales - Pass Guaranteed - A+
Graded
TABLE OF CONTENTS
Section 1 | Exam 1: Perioperative Care and Fluid/Electrolyte Balance | Q1 – Q12
Section 2 | Exam 2: Cardiovascular and Respiratory Disorders | Q13 – Q25
Section 3 | Exam 3: Renal, Gastrointestinal, and Endocrine Disorders | Q26 – Q37
Section 4 | Exam 4: Neurologic, Musculoskeletal, and Immunologic Disorders | Q38 –
Q50
══════════════════════════════════════
SECTION 1: EXAM 1 — PERIOPERATIVE CARE AND FLUID/ELECTROLYTE BALANCE Q1
– Q12
══════════════════════════════════════
Question 1 of 50
A 68-year-old man is admitted for an elective total knee replacement. During the
preoperative assessment, the nurse notes he takes warfarin 5 mg daily for atrial
fibrillation. His INR this morning is 3.2. Which action by the nurse is most appropriate?
A. Proceed with surgery as scheduled and administer vitamin K preoperatively
B. Notify the surgeon and anesthesia provider immediately about the elevated INR
C. Instruct the patient to hold today's warfarin dose and proceed with surgery
D. Administer a prophylactic dose of heparin and document the INR as acceptable
,Correct Answer: B
Rationale: An INR of 3.2 significantly exceeds the therapeutic range and poses a high
risk of intraoperative bleeding, so the surgeon and anesthesia provider must be notified
to determine if the procedure should be postponed or reversed. Holding one dose of
warfarin is insufficient because its effects persist for days, and vitamin K should only be
given per provider order. Communication with the surgical team is the standard of care
when preoperative labs are outside acceptable parameters.
Question 2 of 50
A 54-year-old woman is recovering on the med-surg unit on postoperative day 2 after an
open cholecystectomy. She suddenly reports sharp chest pain and dyspnea. Her SpO2
drops from 96% to 88% on room air. Which nursing intervention takes highest priority?
A. Apply supplemental oxygen via nasal cannula and reassess in 15 minutes
B. Elevate the head of the bed and administer prescribed morphine for pain
C. Encourage deep breathing and coughing to clear secretions
D. Administer a STAT dose of subcutaneous heparin as ordered
Correct Answer: A
Rationale: The sudden onset of chest pain, dyspnea, and hypoxemia in a postoperative
patient is highly suggestive of a pulmonary embolism, and the immediate priority is to
correct hypoxemia with supplemental oxygen while preparing for further evaluation.
Morphine could mask worsening respiratory status, and deep breathing alone will not
address a potential embolus. Heparin administration requires a provider order and does
not take precedence over stabilizing oxygenation.
Question 3 of 50
A 72-year-old man with a history of heart failure is NPO for an upcoming colonoscopy.
He has been receiving D5W at 125 mL/hr for 8 hours. The nurse notes new confusion,
,lethargy, and a blood glucose of 198 mg/dL. Which fluid imbalance is most likely
developing?
A. Hypervolemia from excessive sodium administration
B. Dilutional hyponatremia from free water retention
D. Hyperosmolar hyperglycemic state from glucose overload
C. Dehydration from inadequate fluid replacement
Correct Answer: B
Rationale: D5W is a hypotonic solution that provides free water without electrolytes; in a
patient with heart failure, impaired renal perfusion leads to water retention and
dilutional hyponatremia, which manifests as confusion and lethargy. D5W contains no
sodium, so hypervolemia from sodium is not the primary concern, and the glucose in
D5W is rapidly metabolized, making hyperosmolar state unlikely. The patient's
symptoms reflect cerebral edema from low serum sodium rather than dehydration.
Question 4 of 50
A 45-year-old woman returns to the PACU after laparoscopic appendectomy. The nurse
auscultates absent breath sounds in the right lower lobe and notes shallow respirations
at 18/min. Her temperature is 37.1°C (98.8°F). Which complication is the nurse most
concerned about at this time?
A. Atelectasis from shallow breathing and decreased lung expansion
B. Pneumonia developing from bacterial contamination during surgery
C. Pneumothorax from insufflation gas during laparoscopy
D. Pulmonary edema from excessive intraoperative fluid administration
Correct Answer: A
Rationale: Shallow respirations and absent breath sounds in a dependent lobe
immediately postoperatively are classic for atelectasis, which occurs when alveoli
collapse due to shallow breathing, anesthesia, and supine positioning. Pneumonia
typically develops 48–72 hours postoperatively and would present with fever and
, productive cough, which are absent here. Pneumothorax from laparoscopy is rare and
would more likely cause absent sounds apically with sudden dyspnea.
Question 5 of 50
A 61-year-old man with chronic kidney disease stage 3 is scheduled for an inguinal
hernia repair. His preoperative potassium is 5.8 mEq/L. Which action by the nurse is
most appropriate before sending him to the OR?
A. Administer kayexalate rectally as a standing protocol
B. Hold the surgery and notify the surgeon of the hyperkalemia
C. Increase IV fluids to dilute the potassium level preoperatively
D. Document the value and proceed with the scheduled surgery
Correct Answer: B
Rationale: A potassium level of 5.8 mEq/L exceeds the safe threshold for anesthesia
and surgery because hyperkalemia increases the risk of cardiac dysrhythmias, including
ventricular fibrillation, under general anesthesia. Kayexalate requires a provider order
and is not appropriate without one, and diluting potassium with fluids is ineffective and
dangerous. The surgeon must evaluate whether to treat the hyperkalemia or postpone
the procedure.
Question 6 of 50
A 38-year-old woman is on postoperative day 1 after a total abdominal hysterectomy.
She has a Jackson-Pratt drain in place with 150 mL of serosanguineous output in the
past 4 hours. Her urine output is 25 mL/hr. Which assessment finding warrants
immediate notification of the surgeon?
A. The JP drain output has a faint pink tinge and is slightly odorous
B. The patient's incision edges are slightly erythematous and warm
C. The JP drain suddenly produces 400 mL of bright red blood in one hour
D. The patient's urine has been dark yellow and concentrated all shift
Actual Exam 2026/2027 Complete
Questions and Answers | 100% Verified
Detailed Rationales - Pass Guaranteed - A+
Graded
TABLE OF CONTENTS
Section 1 | Exam 1: Perioperative Care and Fluid/Electrolyte Balance | Q1 – Q12
Section 2 | Exam 2: Cardiovascular and Respiratory Disorders | Q13 – Q25
Section 3 | Exam 3: Renal, Gastrointestinal, and Endocrine Disorders | Q26 – Q37
Section 4 | Exam 4: Neurologic, Musculoskeletal, and Immunologic Disorders | Q38 –
Q50
══════════════════════════════════════
SECTION 1: EXAM 1 — PERIOPERATIVE CARE AND FLUID/ELECTROLYTE BALANCE Q1
– Q12
══════════════════════════════════════
Question 1 of 50
A 68-year-old man is admitted for an elective total knee replacement. During the
preoperative assessment, the nurse notes he takes warfarin 5 mg daily for atrial
fibrillation. His INR this morning is 3.2. Which action by the nurse is most appropriate?
A. Proceed with surgery as scheduled and administer vitamin K preoperatively
B. Notify the surgeon and anesthesia provider immediately about the elevated INR
C. Instruct the patient to hold today's warfarin dose and proceed with surgery
D. Administer a prophylactic dose of heparin and document the INR as acceptable
,Correct Answer: B
Rationale: An INR of 3.2 significantly exceeds the therapeutic range and poses a high
risk of intraoperative bleeding, so the surgeon and anesthesia provider must be notified
to determine if the procedure should be postponed or reversed. Holding one dose of
warfarin is insufficient because its effects persist for days, and vitamin K should only be
given per provider order. Communication with the surgical team is the standard of care
when preoperative labs are outside acceptable parameters.
Question 2 of 50
A 54-year-old woman is recovering on the med-surg unit on postoperative day 2 after an
open cholecystectomy. She suddenly reports sharp chest pain and dyspnea. Her SpO2
drops from 96% to 88% on room air. Which nursing intervention takes highest priority?
A. Apply supplemental oxygen via nasal cannula and reassess in 15 minutes
B. Elevate the head of the bed and administer prescribed morphine for pain
C. Encourage deep breathing and coughing to clear secretions
D. Administer a STAT dose of subcutaneous heparin as ordered
Correct Answer: A
Rationale: The sudden onset of chest pain, dyspnea, and hypoxemia in a postoperative
patient is highly suggestive of a pulmonary embolism, and the immediate priority is to
correct hypoxemia with supplemental oxygen while preparing for further evaluation.
Morphine could mask worsening respiratory status, and deep breathing alone will not
address a potential embolus. Heparin administration requires a provider order and does
not take precedence over stabilizing oxygenation.
Question 3 of 50
A 72-year-old man with a history of heart failure is NPO for an upcoming colonoscopy.
He has been receiving D5W at 125 mL/hr for 8 hours. The nurse notes new confusion,
,lethargy, and a blood glucose of 198 mg/dL. Which fluid imbalance is most likely
developing?
A. Hypervolemia from excessive sodium administration
B. Dilutional hyponatremia from free water retention
D. Hyperosmolar hyperglycemic state from glucose overload
C. Dehydration from inadequate fluid replacement
Correct Answer: B
Rationale: D5W is a hypotonic solution that provides free water without electrolytes; in a
patient with heart failure, impaired renal perfusion leads to water retention and
dilutional hyponatremia, which manifests as confusion and lethargy. D5W contains no
sodium, so hypervolemia from sodium is not the primary concern, and the glucose in
D5W is rapidly metabolized, making hyperosmolar state unlikely. The patient's
symptoms reflect cerebral edema from low serum sodium rather than dehydration.
Question 4 of 50
A 45-year-old woman returns to the PACU after laparoscopic appendectomy. The nurse
auscultates absent breath sounds in the right lower lobe and notes shallow respirations
at 18/min. Her temperature is 37.1°C (98.8°F). Which complication is the nurse most
concerned about at this time?
A. Atelectasis from shallow breathing and decreased lung expansion
B. Pneumonia developing from bacterial contamination during surgery
C. Pneumothorax from insufflation gas during laparoscopy
D. Pulmonary edema from excessive intraoperative fluid administration
Correct Answer: A
Rationale: Shallow respirations and absent breath sounds in a dependent lobe
immediately postoperatively are classic for atelectasis, which occurs when alveoli
collapse due to shallow breathing, anesthesia, and supine positioning. Pneumonia
typically develops 48–72 hours postoperatively and would present with fever and
, productive cough, which are absent here. Pneumothorax from laparoscopy is rare and
would more likely cause absent sounds apically with sudden dyspnea.
Question 5 of 50
A 61-year-old man with chronic kidney disease stage 3 is scheduled for an inguinal
hernia repair. His preoperative potassium is 5.8 mEq/L. Which action by the nurse is
most appropriate before sending him to the OR?
A. Administer kayexalate rectally as a standing protocol
B. Hold the surgery and notify the surgeon of the hyperkalemia
C. Increase IV fluids to dilute the potassium level preoperatively
D. Document the value and proceed with the scheduled surgery
Correct Answer: B
Rationale: A potassium level of 5.8 mEq/L exceeds the safe threshold for anesthesia
and surgery because hyperkalemia increases the risk of cardiac dysrhythmias, including
ventricular fibrillation, under general anesthesia. Kayexalate requires a provider order
and is not appropriate without one, and diluting potassium with fluids is ineffective and
dangerous. The surgeon must evaluate whether to treat the hyperkalemia or postpone
the procedure.
Question 6 of 50
A 38-year-old woman is on postoperative day 1 after a total abdominal hysterectomy.
She has a Jackson-Pratt drain in place with 150 mL of serosanguineous output in the
past 4 hours. Her urine output is 25 mL/hr. Which assessment finding warrants
immediate notification of the surgeon?
A. The JP drain output has a faint pink tinge and is slightly odorous
B. The patient's incision edges are slightly erythematous and warm
C. The JP drain suddenly produces 400 mL of bright red blood in one hour
D. The patient's urine has been dark yellow and concentrated all shift
