NUR 221 Exam 1 Official Exam 2026/2027
Actual Exam Complete Questions and
Answers Detailed Rationales Pass
Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Medical-Surgical Nursing Foundations | Q1 – Q10
Section 2 | Fluid and Electrolyte Balance | Q11 – Q20
Section 3 | Perioperative Nursing Care | Q21 – Q30
Section 4 | Pain Management and Comfort | Q31 – Q40
Section 5 | Wound Care and Skin Integrity | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: MEDICAL-SURGICAL NURSING FOUNDATIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 67-year-old male with a history of chronic obstructive pulmonary disease is admitted
to the medical-surgical unit for an acute exacerbation. His morning vital signs are:
temperature 37.2°C, heart rate 98 bpm, respiratory rate 24/min, blood pressure 142/88
mmHg, and SpO₂ 88% on 2 L/min nasal cannula. He reports increased dyspnea and a
productive cough with green sputum. Which nursing action is the priority?
A. Increase the oxygen flow rate to 4 L/min to improve his SpO₂ to 92%.
B. Administer the prescribed bronchodilator via nebulizer and reassess breath sounds.
C. Obtain a sputum specimen for culture and sensitivity before starting antibiotics.
D. Encourage the patient to perform pursed-lip breathing exercises every hour.
Correct Answer: B
,Rationale: Bronchodilator administration is the priority because it directly addresses
airway obstruction and bronchospasm, which are the primary drivers of the patient's
dyspnea and low oxygen saturation. Increasing oxygen without addressing airway
obstruction first may mask worsening respiratory status and does not treat the
underlying problem. In COPD exacerbations, bronchodilators are the cornerstone of
initial management before other interventions.
Question 2 of 50
A 54-year-old female with newly diagnosed type 2 diabetes is being discharged home
after a 3-day hospitalization for hyperglycemic hyperosmolar state. Her discharge
medications include metformin 1000 mg twice daily. During discharge teaching, she
asks why she needs to temporarily stop this medication before her scheduled contrast
CT scan next week. Which response by the nurse is most accurate?
A. "The contrast dye can interact with metformin and cause a dangerous drop in your
blood sugar."
B. "Metformin increases the risk of lactic acidosis when combined with iodinated
contrast media, so we hold it for 48 hours."
C. "The dye makes metformin less effective, so we pause it until your kidneys fully
recover from the scan."
D. "Stopping metformin prevents the contrast from causing severe nausea and vomiting
during the procedure."
Correct Answer: B
Rationale: Iodinated contrast media can impair renal perfusion, and when combined
with metformin, there is a risk of lactic acidosis due to reduced renal clearance of the
drug. The standard protocol is to hold metformin for 48 hours before and after contrast
administration, then resume once renal function is confirmed stable. The other options
misrepresent the mechanism; the concern is not hypoglycemia, drug effectiveness, or
nausea.
,Question 3 of 50
A 72-year-old male is admitted to the medical-surgical unit with community-acquired
pneumonia. His medical history includes hypertension, benign prostatic hyperplasia,
and a penicillin allergy. The physician orders levofloxacin 750 mg IV daily. Before
administering the first dose, the nurse reviews the patient's current medications and
notes he is taking warfarin 5 mg daily with an INR of 2.8. Which action should the nurse
take first?
A. Administer the levofloxacin as ordered and monitor the patient for signs of bleeding.
B. Hold the warfarin dose and notify the physician about the potential drug interaction.
C. Contact the pharmacist to verify compatibility between levofloxacin and warfarin.
D. Notify the physician that the patient's INR is above therapeutic range before giving
the antibiotic.
Correct Answer: D
Rationale: Fluoroquinolones like levofloxacin can potentiate the anticoagulant effect of
warfarin, further elevating the INR and increasing bleeding risk; the physician needs to
know the baseline INR and potential interaction before the first dose. Holding warfarin
without physician orders is outside nursing scope, and while pharmacist consultation is
valuable, the prescriber must be informed first to adjust either the antibiotic choice or
anticoagulation plan. An INR of 2.8 is at the upper limit of therapeutic range, making this
interaction clinically significant.
Question 4 of 50
A 45-year-old female is recovering on the medical-surgical unit 24 hours after an open
cholecystectomy. She has a Jackson-Pratt drain in place with 45 mL of
serosanguineous output in the past 8 hours. During the evening assessment, she
reports increasing abdominal pain, her temperature is 38.6°C, and the drainage has
, become frankly purulent with a foul odor. Which finding requires the most immediate
nursing intervention?
A. The temperature elevation indicating a possible surgical site infection.
B. The change in drainage character suggesting an intra-abdominal abscess.
C. The 45 mL output volume over 8 hours indicating excessive drainage.
D. The increasing pain level requiring stronger analgesic administration.
Correct Answer: B
Rationale: Frankly purulent drainage with foul odor from a postoperative drain indicates
an established intra-abdominal infection or abscess, which can rapidly progress to
sepsis if not addressed immediately with physician notification and likely drainage
revision. While fever and pain are important, the character of the drainage is the most
specific indicator of a serious infectious complication that requires urgent intervention.
The output volume of 45 mL is actually within expected range for a JP drain in the first
24-48 hours.
Question 5 of 50
A 58-year-old male with a history of heart failure is admitted for worsening dyspnea and
peripheral edema. His admission weight is 82 kg, up 4 kg from his baseline. The
physician orders furosemide 40 mg IV push twice daily. On the second day of
hospitalization, the nurse notes the patient's urine output over the past 8 hours is 1800
mL, his blood pressure is 98/62 mmHg, and he reports feeling lightheaded when
standing. Which adjustment to the plan of care is most appropriate?
A. Continue the current diuretic schedule and increase oral fluid intake to prevent
dehydration.
B. Hold the next dose of furosemide and notify the physician of the hypotension and
orthostatic symptoms.
C. Administer the furosemide more slowly via IV infusion to reduce the hypotensive
effect.
D. Obtain a stat basic metabolic panel to check for hypokalemia before the next dose.
Actual Exam Complete Questions and
Answers Detailed Rationales Pass
Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Medical-Surgical Nursing Foundations | Q1 – Q10
Section 2 | Fluid and Electrolyte Balance | Q11 – Q20
Section 3 | Perioperative Nursing Care | Q21 – Q30
Section 4 | Pain Management and Comfort | Q31 – Q40
Section 5 | Wound Care and Skin Integrity | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: MEDICAL-SURGICAL NURSING FOUNDATIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 67-year-old male with a history of chronic obstructive pulmonary disease is admitted
to the medical-surgical unit for an acute exacerbation. His morning vital signs are:
temperature 37.2°C, heart rate 98 bpm, respiratory rate 24/min, blood pressure 142/88
mmHg, and SpO₂ 88% on 2 L/min nasal cannula. He reports increased dyspnea and a
productive cough with green sputum. Which nursing action is the priority?
A. Increase the oxygen flow rate to 4 L/min to improve his SpO₂ to 92%.
B. Administer the prescribed bronchodilator via nebulizer and reassess breath sounds.
C. Obtain a sputum specimen for culture and sensitivity before starting antibiotics.
D. Encourage the patient to perform pursed-lip breathing exercises every hour.
Correct Answer: B
,Rationale: Bronchodilator administration is the priority because it directly addresses
airway obstruction and bronchospasm, which are the primary drivers of the patient's
dyspnea and low oxygen saturation. Increasing oxygen without addressing airway
obstruction first may mask worsening respiratory status and does not treat the
underlying problem. In COPD exacerbations, bronchodilators are the cornerstone of
initial management before other interventions.
Question 2 of 50
A 54-year-old female with newly diagnosed type 2 diabetes is being discharged home
after a 3-day hospitalization for hyperglycemic hyperosmolar state. Her discharge
medications include metformin 1000 mg twice daily. During discharge teaching, she
asks why she needs to temporarily stop this medication before her scheduled contrast
CT scan next week. Which response by the nurse is most accurate?
A. "The contrast dye can interact with metformin and cause a dangerous drop in your
blood sugar."
B. "Metformin increases the risk of lactic acidosis when combined with iodinated
contrast media, so we hold it for 48 hours."
C. "The dye makes metformin less effective, so we pause it until your kidneys fully
recover from the scan."
D. "Stopping metformin prevents the contrast from causing severe nausea and vomiting
during the procedure."
Correct Answer: B
Rationale: Iodinated contrast media can impair renal perfusion, and when combined
with metformin, there is a risk of lactic acidosis due to reduced renal clearance of the
drug. The standard protocol is to hold metformin for 48 hours before and after contrast
administration, then resume once renal function is confirmed stable. The other options
misrepresent the mechanism; the concern is not hypoglycemia, drug effectiveness, or
nausea.
,Question 3 of 50
A 72-year-old male is admitted to the medical-surgical unit with community-acquired
pneumonia. His medical history includes hypertension, benign prostatic hyperplasia,
and a penicillin allergy. The physician orders levofloxacin 750 mg IV daily. Before
administering the first dose, the nurse reviews the patient's current medications and
notes he is taking warfarin 5 mg daily with an INR of 2.8. Which action should the nurse
take first?
A. Administer the levofloxacin as ordered and monitor the patient for signs of bleeding.
B. Hold the warfarin dose and notify the physician about the potential drug interaction.
C. Contact the pharmacist to verify compatibility between levofloxacin and warfarin.
D. Notify the physician that the patient's INR is above therapeutic range before giving
the antibiotic.
Correct Answer: D
Rationale: Fluoroquinolones like levofloxacin can potentiate the anticoagulant effect of
warfarin, further elevating the INR and increasing bleeding risk; the physician needs to
know the baseline INR and potential interaction before the first dose. Holding warfarin
without physician orders is outside nursing scope, and while pharmacist consultation is
valuable, the prescriber must be informed first to adjust either the antibiotic choice or
anticoagulation plan. An INR of 2.8 is at the upper limit of therapeutic range, making this
interaction clinically significant.
Question 4 of 50
A 45-year-old female is recovering on the medical-surgical unit 24 hours after an open
cholecystectomy. She has a Jackson-Pratt drain in place with 45 mL of
serosanguineous output in the past 8 hours. During the evening assessment, she
reports increasing abdominal pain, her temperature is 38.6°C, and the drainage has
, become frankly purulent with a foul odor. Which finding requires the most immediate
nursing intervention?
A. The temperature elevation indicating a possible surgical site infection.
B. The change in drainage character suggesting an intra-abdominal abscess.
C. The 45 mL output volume over 8 hours indicating excessive drainage.
D. The increasing pain level requiring stronger analgesic administration.
Correct Answer: B
Rationale: Frankly purulent drainage with foul odor from a postoperative drain indicates
an established intra-abdominal infection or abscess, which can rapidly progress to
sepsis if not addressed immediately with physician notification and likely drainage
revision. While fever and pain are important, the character of the drainage is the most
specific indicator of a serious infectious complication that requires urgent intervention.
The output volume of 45 mL is actually within expected range for a JP drain in the first
24-48 hours.
Question 5 of 50
A 58-year-old male with a history of heart failure is admitted for worsening dyspnea and
peripheral edema. His admission weight is 82 kg, up 4 kg from his baseline. The
physician orders furosemide 40 mg IV push twice daily. On the second day of
hospitalization, the nurse notes the patient's urine output over the past 8 hours is 1800
mL, his blood pressure is 98/62 mmHg, and he reports feeling lightheaded when
standing. Which adjustment to the plan of care is most appropriate?
A. Continue the current diuretic schedule and increase oral fluid intake to prevent
dehydration.
B. Hold the next dose of furosemide and notify the physician of the hypotension and
orthostatic symptoms.
C. Administer the furosemide more slowly via IV infusion to reduce the hypotensive
effect.
D. Obtain a stat basic metabolic panel to check for hypokalemia before the next dose.
