NUR 242 MED SURG EXAM 1 – PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
- Perioperative Nursing Care
- Fluid and Electrolyte Imbalances
- Acid-Base Balance and Interpretation
- Pain Management and Pharmacology
- Palliative and End-of-Life Care
- Assessment of Respiratory Function
- Management of Patients with Upper Respiratory Disorders
- Management of Patients with Chest and Lower Respiratory Tract Disorders
- Integumentary System and Wound Care
- Surgical Complications and Nursing Interventions
Introduction
The purpose of this comprehensive assessment is to evaluate the student’s mastery of foundational and
advanced Medical-Surgical nursing concepts as presented in the NUR 242 curriculum. This exam focuses on the
integration of physiological processes, clinical judgment, and evidence-based practice necessary for the delivery
of safe patient care. The assessment is composed of multiple-choice and complex scenario-based questions
designed to challenge the student’s ability to prioritize interventions and apply critical thinking to clinical situations.
Emphasis is placed on real-world application, patient safety, interdisciplinary collaboration, and the nursing
process within acute care settings.
Section One: Questions 1–100
, 1. A nurse is caring for a patient who is 4 hours postoperative following abdominal surgery. The patient's
blood pressure has dropped from 120/80 mmHg to 94/60 mmHg, and the heart rate has increased from 82
to 114 bpm. Which action should the nurse take first?
A. Increase the rate of the prescribed maintenance IV fluids.
B. Administer the ordered PRN pain medication.
C. Assess the surgical dressing and site for hemorrhage.
D. Place the patient in a High-Fowler’s position.
🟢 C. Assess the surgical dressing and site for hemorrhage.
🔴 RATIONALE: The patient is exhibiting clinical signs of hypovolemic shock (tachycardia and hypotension);
assessing for the source of potential bleeding is the priority nursing action before interventions.
2. A patient with a history of COPD is admitted with increased shortness of breath. The arterial blood gas
(ABG) results are: pH 7.30, PaCO2 52 mmHg, and HCO3 26 mEq/L. How should the nurse interpret these
results?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
🟢 B. Respiratory Acidosis
🔴 RATIONALE: A pH below 7.35 indicates acidosis, and a PaCO2 above 45 mmHg indicates a respiratory origin,
common in patients with COPD who retain carbon dioxide.
, 3. During the preoperative interview, a patient mentions an allergy to bananas and avocados. Which action by
the nurse is most critical?
A. Document the food allergy in the dietary section of the chart.
B. Notify the surgical team to prepare for a latex-free environment.
C. Ask the patient if they have ever had a reaction to peanuts.
D. Reassure the patient that these foods will not be served in the hospital.
🟢 B. Notify the surgical team to prepare for a latex-free environment.
🔴 RATIONALE: There is a known cross-sensitivity between certain foods like bananas/avocados and latex;
identifying this risk is essential to prevent intraoperative anaphylaxis.
4. A nurse is providing discharge teaching for a patient with a new prescription for warfarin. Which statement
by the patient indicates a need for further teaching?
A. "I will use an electric razor for shaving."
B. "I should avoid making sudden changes to my intake of green leafy vegetables."
C. "I will take aspirin if I develop a headache."
D. "I need to report any unusual bruising to my doctor immediately."
🟢 C. "I will take aspirin if I develop a headache."
🔴 RATIONALE: Aspirin has antiplatelet properties that can significantly increase the risk of bleeding when
combined with warfarin; patients should use non-NSAID alternatives for pain.
5. A patient is receiving a unit of packed red blood cells (PRBCs). Fifteen minutes into the transfusion, the
patient reports chills, back pain, and shortness of breath. What is the nurse's immediate priority?
, A. Slow the infusion rate and notify the physician.
B. Stop the transfusion and disconnect the tubing at the hub.
C. Administer diphenhydramine as ordered.
D. Check the patient's temperature and blood pressure.
🟢 B. Stop the transfusion and disconnect the tubing at the hub.
🔴 RATIONALE: These symptoms suggest a hemolytic transfusion reaction; the immediate priority is to stop the
flow of the blood product to prevent further reaction.
6. Which assessment finding in a patient with a chest tube requires immediate intervention by the nurse?
A. 100 mL of serosanguinous drainage in the collection chamber over 4 hours.
B. Constant bubbling in the water seal chamber.
C. Fluctuations (tidaling) in the water seal chamber with respiration.
D. Patient reporting mild discomfort at the insertion site.
🟢 B. Constant bubbling in the water seal chamber.
🔴 RATIONALE: Constant bubbling in the water seal chamber typically indicates an air leak in the system,
whereas tidaling is a normal and expected finding.
7. An older adult patient is 2 days postoperative. The nurse notes the patient is suddenly confused, agitated,
and attempting to pull out the IV line. Which condition should the nurse suspect first?
A. Dementia
B. Delirium
C. Depression
D. Normal aging process
PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
- Perioperative Nursing Care
- Fluid and Electrolyte Imbalances
- Acid-Base Balance and Interpretation
- Pain Management and Pharmacology
- Palliative and End-of-Life Care
- Assessment of Respiratory Function
- Management of Patients with Upper Respiratory Disorders
- Management of Patients with Chest and Lower Respiratory Tract Disorders
- Integumentary System and Wound Care
- Surgical Complications and Nursing Interventions
Introduction
The purpose of this comprehensive assessment is to evaluate the student’s mastery of foundational and
advanced Medical-Surgical nursing concepts as presented in the NUR 242 curriculum. This exam focuses on the
integration of physiological processes, clinical judgment, and evidence-based practice necessary for the delivery
of safe patient care. The assessment is composed of multiple-choice and complex scenario-based questions
designed to challenge the student’s ability to prioritize interventions and apply critical thinking to clinical situations.
Emphasis is placed on real-world application, patient safety, interdisciplinary collaboration, and the nursing
process within acute care settings.
Section One: Questions 1–100
, 1. A nurse is caring for a patient who is 4 hours postoperative following abdominal surgery. The patient's
blood pressure has dropped from 120/80 mmHg to 94/60 mmHg, and the heart rate has increased from 82
to 114 bpm. Which action should the nurse take first?
A. Increase the rate of the prescribed maintenance IV fluids.
B. Administer the ordered PRN pain medication.
C. Assess the surgical dressing and site for hemorrhage.
D. Place the patient in a High-Fowler’s position.
🟢 C. Assess the surgical dressing and site for hemorrhage.
🔴 RATIONALE: The patient is exhibiting clinical signs of hypovolemic shock (tachycardia and hypotension);
assessing for the source of potential bleeding is the priority nursing action before interventions.
2. A patient with a history of COPD is admitted with increased shortness of breath. The arterial blood gas
(ABG) results are: pH 7.30, PaCO2 52 mmHg, and HCO3 26 mEq/L. How should the nurse interpret these
results?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
🟢 B. Respiratory Acidosis
🔴 RATIONALE: A pH below 7.35 indicates acidosis, and a PaCO2 above 45 mmHg indicates a respiratory origin,
common in patients with COPD who retain carbon dioxide.
, 3. During the preoperative interview, a patient mentions an allergy to bananas and avocados. Which action by
the nurse is most critical?
A. Document the food allergy in the dietary section of the chart.
B. Notify the surgical team to prepare for a latex-free environment.
C. Ask the patient if they have ever had a reaction to peanuts.
D. Reassure the patient that these foods will not be served in the hospital.
🟢 B. Notify the surgical team to prepare for a latex-free environment.
🔴 RATIONALE: There is a known cross-sensitivity between certain foods like bananas/avocados and latex;
identifying this risk is essential to prevent intraoperative anaphylaxis.
4. A nurse is providing discharge teaching for a patient with a new prescription for warfarin. Which statement
by the patient indicates a need for further teaching?
A. "I will use an electric razor for shaving."
B. "I should avoid making sudden changes to my intake of green leafy vegetables."
C. "I will take aspirin if I develop a headache."
D. "I need to report any unusual bruising to my doctor immediately."
🟢 C. "I will take aspirin if I develop a headache."
🔴 RATIONALE: Aspirin has antiplatelet properties that can significantly increase the risk of bleeding when
combined with warfarin; patients should use non-NSAID alternatives for pain.
5. A patient is receiving a unit of packed red blood cells (PRBCs). Fifteen minutes into the transfusion, the
patient reports chills, back pain, and shortness of breath. What is the nurse's immediate priority?
, A. Slow the infusion rate and notify the physician.
B. Stop the transfusion and disconnect the tubing at the hub.
C. Administer diphenhydramine as ordered.
D. Check the patient's temperature and blood pressure.
🟢 B. Stop the transfusion and disconnect the tubing at the hub.
🔴 RATIONALE: These symptoms suggest a hemolytic transfusion reaction; the immediate priority is to stop the
flow of the blood product to prevent further reaction.
6. Which assessment finding in a patient with a chest tube requires immediate intervention by the nurse?
A. 100 mL of serosanguinous drainage in the collection chamber over 4 hours.
B. Constant bubbling in the water seal chamber.
C. Fluctuations (tidaling) in the water seal chamber with respiration.
D. Patient reporting mild discomfort at the insertion site.
🟢 B. Constant bubbling in the water seal chamber.
🔴 RATIONALE: Constant bubbling in the water seal chamber typically indicates an air leak in the system,
whereas tidaling is a normal and expected finding.
7. An older adult patient is 2 days postoperative. The nurse notes the patient is suddenly confused, agitated,
and attempting to pull out the IV line. Which condition should the nurse suspect first?
A. Dementia
B. Delirium
C. Depression
D. Normal aging process
