NU 155 Exam 3 Medical-Surgical Nursing I Actual Exam
2026/2027: Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
TABLE OF CONTENTS
Section 1 | Perioperative Nursing Care | Q1 – Q10
Section 2 | Fluid and Electrolyte Balance | Q11 – Q20
Section 3 | Pain Management and Comfort | Q21 – Q30
Section 4 | Integumentary and Wound Care | Q31 – Q40
Section 5 | Infection Prevention and Immunologic Response | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: PERIOPERATIVE NURSING CARE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man is scheduled for elective total knee replacement in 3 days. During the
preoperative assessment, he mentions he takes warfarin 5 mg daily for atrial fibrillation
and his last dose was this morning.
A. Continue warfarin through the morning of surgery because stopping increases
thromboembolic risk.
B. Hold warfarin now and bridge with low-molecular-weight heparin per protocol to
balance clotting and bleeding risk. ✓ CORRECT
C. Switch to aspirin 325 mg daily until surgery to maintain anticoagulation without
warfarin's bleeding risk.
D. Increase the warfarin dose to 7.5 mg for the next 2 days to build a therapeutic reserve
before surgery.
Correct Answer: B
,Rationale: Warfarin must be held before major surgery to prevent excessive bleeding,
and bridging with LMWH maintains protection from thromboembolism during the
perioperative window. Continuing warfarin through surgery creates unacceptable
bleeding risk, and aspirin is not an adequate substitute for anticoagulation in atrial
fibrillation. Preoperative clinics coordinate these holds with the surgeon and
anesthesiologist well in advance.
Question 2 of 50
A 45-year-old woman is in the PACU after laparoscopic cholecystectomy. The nurse
notes she is restless, her oxygen saturation is 91% on 2 L nasal cannula, and her
respiratory rate is 28.
A. Increase the oxygen flow to 6 L and reassess in 15 minutes because she likely has
residual anesthesia effects.
B. Administer a bolus of IV morphine to calm the patient and reduce the respiratory
drive from anxiety.
C. Place the patient in reverse Trendelenburg to improve diaphragmatic excursion and
lung expansion.
D. Assess for airway obstruction, auscultate breath sounds, and encourage deep
breathing with incentive spirometry. ✓ CORRECT
Correct Answer: D
Rationale: Postoperative hypoxemia and restlessness often indicate atelectasis or
airway compromise, so assessment and pulmonary interventions take priority over
sedation or passive oxygen increases. Morphine would further depress respiration and
mask deterioration. Reverse Trendelenburg impedes diaphragmatic function rather than
improving it. PACU nurses intervene aggressively with pulmonary toilet because
atelectasis develops rapidly after abdominal surgery.
Question 3 of 50
,A 22-year-old college athlete is having ACL reconstruction under general anesthesia.
The circulating nurse notes the patient's skin is warm and flushed, the end-tidal CO2 is
rising, and the heart rate is 128.
A. Recognize this as malignant hyperthermia, discontinue triggering agents, and prepare
dantrolene. ✓ CORRECT
B. Administer atropine to treat the tachycardia and apply cooling blankets for the
elevated temperature.
C. Increase the volatile anesthetic to deepen the plane and reduce the hypermetabolic
response.
D. Give a beta-blocker to control the heart rate while continuing the current anesthetic
regimen.
Correct Answer: A
Rationale: Warm flushed skin, rising ETCO2, and tachycardia in a patient receiving
volatile anesthetics is the classic presentation of malignant hyperthermia, requiring
immediate discontinuation of triggers and dantrolene administration. Atropine worsens
the hypermetabolic state, and deepening anesthesia with the triggering agent
exacerbates the crisis. Beta-blockers mask tachycardia without addressing the
underlying ryanodine receptor hyperactivity. Malignant hyperthermia is a true anesthesia
emergency with a narrow treatment window.
Question 4 of 50
A 55-year-old man is 24 hours post-op from a right hemicolectomy. His nasogastric tube
is draining 800 mL of dark green fluid in 8 hours, and he complains of abdominal
distension.
A. Remove the nasogastric tube because the output color indicates the stomach is
decompressed and ready for oral intake.
B. Advance the NG tube 5 cm and apply low intermittent suction to improve gastric
decompression.
C. Maintain the NG tube to low continuous suction, monitor electrolytes, and keep the
patient NPO until bowel sounds return. ✓ CORRECT
, D. Begin clear liquids orally to stimulate peristalsis and reduce the ileus from prolonged
NPO status.
Correct Answer: C
Rationale: High-volume bilious output with distension indicates postoperative ileus,
requiring continued NG decompression, NPO status, and electrolyte monitoring until
bowel function returns. Removing the tube with active drainage risks aspiration and
worsening distension. Advancing the tube is unnecessary and potentially traumatic.
Oral intake during ileus increases vomiting, aspiration risk, and anastomotic stress.
Postoperative ileus typically resolves in 2-3 days with supportive care.
Question 5 of 50
A 38-year-old woman is receiving patient-controlled analgesia with morphine after
abdominal hysterectomy. The nurse finds her difficult to arouse, with a respiratory rate
of 8 and pinpoint pupils.
A. Continue the PCA as ordered because sedation is expected with adequate pain
control after major surgery.
B. Administer naloxone per protocol, stop the PCA infusion, and prepare for respiratory
support. ✓ CORRECT
C. Stimulate the patient with a sternal rub and place her in a lateral position to protect
the airway.
D. Reduce the PCA demand dose by half and increase the lockout interval to prevent
future oversedation.
Correct Answer: B
Rationale: Respiratory depression, unresponsiveness, and pinpoint pupils are classic
signs of opioid overdose requiring immediate naloxone reversal and discontinuation of
the infusion. Continuing the PCA is lethal, and sternal rubs do not reverse respiratory
depression. Reducing settings is appropriate after the acute event is managed but does
2026/2027: Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
TABLE OF CONTENTS
Section 1 | Perioperative Nursing Care | Q1 – Q10
Section 2 | Fluid and Electrolyte Balance | Q11 – Q20
Section 3 | Pain Management and Comfort | Q21 – Q30
Section 4 | Integumentary and Wound Care | Q31 – Q40
Section 5 | Infection Prevention and Immunologic Response | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: PERIOPERATIVE NURSING CARE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man is scheduled for elective total knee replacement in 3 days. During the
preoperative assessment, he mentions he takes warfarin 5 mg daily for atrial fibrillation
and his last dose was this morning.
A. Continue warfarin through the morning of surgery because stopping increases
thromboembolic risk.
B. Hold warfarin now and bridge with low-molecular-weight heparin per protocol to
balance clotting and bleeding risk. ✓ CORRECT
C. Switch to aspirin 325 mg daily until surgery to maintain anticoagulation without
warfarin's bleeding risk.
D. Increase the warfarin dose to 7.5 mg for the next 2 days to build a therapeutic reserve
before surgery.
Correct Answer: B
,Rationale: Warfarin must be held before major surgery to prevent excessive bleeding,
and bridging with LMWH maintains protection from thromboembolism during the
perioperative window. Continuing warfarin through surgery creates unacceptable
bleeding risk, and aspirin is not an adequate substitute for anticoagulation in atrial
fibrillation. Preoperative clinics coordinate these holds with the surgeon and
anesthesiologist well in advance.
Question 2 of 50
A 45-year-old woman is in the PACU after laparoscopic cholecystectomy. The nurse
notes she is restless, her oxygen saturation is 91% on 2 L nasal cannula, and her
respiratory rate is 28.
A. Increase the oxygen flow to 6 L and reassess in 15 minutes because she likely has
residual anesthesia effects.
B. Administer a bolus of IV morphine to calm the patient and reduce the respiratory
drive from anxiety.
C. Place the patient in reverse Trendelenburg to improve diaphragmatic excursion and
lung expansion.
D. Assess for airway obstruction, auscultate breath sounds, and encourage deep
breathing with incentive spirometry. ✓ CORRECT
Correct Answer: D
Rationale: Postoperative hypoxemia and restlessness often indicate atelectasis or
airway compromise, so assessment and pulmonary interventions take priority over
sedation or passive oxygen increases. Morphine would further depress respiration and
mask deterioration. Reverse Trendelenburg impedes diaphragmatic function rather than
improving it. PACU nurses intervene aggressively with pulmonary toilet because
atelectasis develops rapidly after abdominal surgery.
Question 3 of 50
,A 22-year-old college athlete is having ACL reconstruction under general anesthesia.
The circulating nurse notes the patient's skin is warm and flushed, the end-tidal CO2 is
rising, and the heart rate is 128.
A. Recognize this as malignant hyperthermia, discontinue triggering agents, and prepare
dantrolene. ✓ CORRECT
B. Administer atropine to treat the tachycardia and apply cooling blankets for the
elevated temperature.
C. Increase the volatile anesthetic to deepen the plane and reduce the hypermetabolic
response.
D. Give a beta-blocker to control the heart rate while continuing the current anesthetic
regimen.
Correct Answer: A
Rationale: Warm flushed skin, rising ETCO2, and tachycardia in a patient receiving
volatile anesthetics is the classic presentation of malignant hyperthermia, requiring
immediate discontinuation of triggers and dantrolene administration. Atropine worsens
the hypermetabolic state, and deepening anesthesia with the triggering agent
exacerbates the crisis. Beta-blockers mask tachycardia without addressing the
underlying ryanodine receptor hyperactivity. Malignant hyperthermia is a true anesthesia
emergency with a narrow treatment window.
Question 4 of 50
A 55-year-old man is 24 hours post-op from a right hemicolectomy. His nasogastric tube
is draining 800 mL of dark green fluid in 8 hours, and he complains of abdominal
distension.
A. Remove the nasogastric tube because the output color indicates the stomach is
decompressed and ready for oral intake.
B. Advance the NG tube 5 cm and apply low intermittent suction to improve gastric
decompression.
C. Maintain the NG tube to low continuous suction, monitor electrolytes, and keep the
patient NPO until bowel sounds return. ✓ CORRECT
, D. Begin clear liquids orally to stimulate peristalsis and reduce the ileus from prolonged
NPO status.
Correct Answer: C
Rationale: High-volume bilious output with distension indicates postoperative ileus,
requiring continued NG decompression, NPO status, and electrolyte monitoring until
bowel function returns. Removing the tube with active drainage risks aspiration and
worsening distension. Advancing the tube is unnecessary and potentially traumatic.
Oral intake during ileus increases vomiting, aspiration risk, and anastomotic stress.
Postoperative ileus typically resolves in 2-3 days with supportive care.
Question 5 of 50
A 38-year-old woman is receiving patient-controlled analgesia with morphine after
abdominal hysterectomy. The nurse finds her difficult to arouse, with a respiratory rate
of 8 and pinpoint pupils.
A. Continue the PCA as ordered because sedation is expected with adequate pain
control after major surgery.
B. Administer naloxone per protocol, stop the PCA infusion, and prepare for respiratory
support. ✓ CORRECT
C. Stimulate the patient with a sternal rub and place her in a lateral position to protect
the airway.
D. Reduce the PCA demand dose by half and increase the lockout interval to prevent
future oversedation.
Correct Answer: B
Rationale: Respiratory depression, unresponsiveness, and pinpoint pupils are classic
signs of opioid overdose requiring immediate naloxone reversal and discontinuation of
the infusion. Continuing the PCA is lethal, and sternal rubs do not reverse respiratory
depression. Reducing settings is appropriate after the acute event is managed but does
