NURS 320 EXAM QUESTIONS AND ANSWERS
2024/2025 REAL EXAM GRADED A+
An adult male is scheduled for surgery and the nurse is assessing for risk factors. Which is the
following are the greatest risk factors?
1.) He is 5ft 4 in tall and weighs 125 lb
2.) He expressed a fear of pain in the post-op period.
3.) He is 5ft 4 in tall, weighs 360lb, and is diabetic.
4.) He expresses fear of the unknown.
3.)He is 5ft 4 in tall, weighs 360lb, and is diabetic
The nurse in an outclient department is interviewing an adult one week prior to her scheduled
elective surgery. In planning for the surgery, which of the following should the nurse include in
her teaching?
1.) The client will be able to return home alone following the surgery.
2.) Limitations of oral intake the day of the procedure.
3.) The laboratory studies ordered do not need to be done until after the surgery.
4.) The client should not take any of her routine medications the morning of the surgery.
2.) Instructions should be given to the client regarding limitations or oral intake to avoid nausea
and vomiting for anesthesia.
The nurse enters a woman's room to administer 10mg Valium PO, the ordered pre-op medication
for her hysterectomy. During the conversation, the client tells the nurse that she and her husband
are planning to have another child in the coming year. The best action for the nurse to take is
which of the following?
1.) Do not administer the pre-op medication. NOtify the nursing supervisor and the physician.
2.) Go ahead and administer the medication as ordered.
3.) Check to see if the client has signed a surgical consent.
4.)Send the client to the OR without the medication.
1.)no client should be administered the per-op med until the informed consent has been obtained.
Even if the consent form is signed, the nurse should withhold sedating meds because this client
clearly does not understand the planned procedure.
The nurse administers 10mg IM morphine as a pre-op medication, and then discovers that there
is no signed operative permit. The best action for the nurse to take is to:
,1.) Send the client to surgery as scheduled.
2.) notify the nursing supervisor, the OR, and the physician.
3.) cancel surgery immediately
4.) obtain the needed constent.
2.)is a narcotic, sedative, or tranquilizing drug has been administered before signing of the
consent, the drug's effects must be allowed to wear off before consent can be given.
An adult received atropine sulfate (Atropine) as a pre-op medication 30 minutes ago and is now
complaining of dry mouth and her pulse rate is higher than before the medication was
administered. The nurse's best interpretation of these findings is that:
1.) The client is having an allergic reaction to the drug.
2.) the client needs a higher dose of this drug
3.) this is a normal side effect of Atropine
4.) the client is anxious about the upcoming surgery.
3.) These are normal side effects of an anticholinergic drug; adverse side effects would include
ECG changes, constipation, and urinary retention.
An adult with COPD is scheduled for surgery and the physician has recommended an epidural
anesthetic. The nurse should know that general anesthesia was not recommended for this client
because:
1.)there is too high a risk for pressure sores to develop
2.) there is less effect on the respiratory system with epidural anesthesia.
3.) CNS control of the vascular constriction would be affected with general anesthesia.
4.) there is too high a risk of lacerations to the mouth, bruising of lips, and damage to teeth.
2.) Epidural anesthesia does not cause resp. depression, but general anesthesia can. especially in
a client with COPD.
A patient is now in the recovery room after having vaginal surgery. Due to the positioning of the
procedure, you would want to assess for what while the patient is in recovery?
A. Bowel Sounds
B. Dysrhythmia
C. Homan's Sign
D. Hemoglobin Level
C
After surgery your patient is semicomatose with vital signs within normal limits. As the nurse,
what position would be best for this patient?
A. Semi-Fowlers
B. Prone
C. Low-Fowlers
D. Side positioning preferably on the left side
,D
After surgery your patient starts to shiver uncontrollably. What nursing intervention would you
do FIRST?*
A. Apply warm blankets & continue oxygen as prescribed
B. Take the patient's rectal temperature
C. Page the doctor for further orders
D. Adjust the thermostat in the room
A
The nurse is monitoring the patient who is 24 hours post-opt from surgery. Which finding
requires intervention?*
A. BP 100/80
B. 24-hour urine output of 300 ml
C. Pain rating of 4 on 1-10 scale
D. Temperature of 99.3' F
B
A patient is 6 days post-opt from abdominal surgery. The patient is to be discharged later today.
The patient uses the call light and asks you to come to his room and look at his surgical site. On
arrival, you see that approximately 2 inches of internal organs are protruding through the
incision. What intervention would you NOT do?*
A. Put the patient in prone position with knees extended to put pressure on the site
B. Cover the wound with sterile normal saline dressing
C. Monitor for signs of shock
D. Notify the MD and administer as prescribed antiemetic to prevent vomiting
A
A patient reports he hasn't had a bowel movement or passed gas since surgery. On assessment,
you note the abdomen is distended and no bowel sounds are noted in the four quadrants. You
notify the MD. What non-invasive nursing interventions can you perform without a MD order?
A. Insert a nasogastric attached to intermittent suction
B. Administer IV fluids
C. Encourage ambulation, maintain NPO status, and monitor intake & output
D. Encourage at least 3000 ml of fluids per day
C
What is a potential postoperative concern regarding a patient who has already resumed a solid
diet?*
A. Failure to pass stool within 12 hours of eating solid foods
B. Failure to pass stool within 48 hours of eating solid foods
C. Passage of excessive flatus
D. Patient reports a decreased appetite
, B
A nurse is developing a care plan for a patient who is at risk for developing pneumonia after
surgery. Which of the following is not an appropriate nursing intervention?*
A. Encourage patient intake of 3000 ml/day of fluids if not contraindicated
B. Encourage patient to use the incentive spirometer device 10 times every 1-2 hours while
awake
C. Encourage early ambulation and patient to eat meals in beside chair
D. Repositioning every 3-4 hours
D
When assessing your patient who is post-opt, you notice that the patient's right calf vein feels
hard, cord-like, and is tender to the touch. The patient reports it is aching and painful. What
would NOT be an appropriate nursing intervention for this patient?*
A. Allow the patient to dangle the legs to help increase circulation and alleviate pain
B. Instruct the patient to not sit in one position for a long period of time
C. Elevate the extremity 30 degrees without allowing any pressure on affected area
D. Administer anticoagulants as ordered by MD
A
A patient is recovering from surgery. The patient is very restless, heart rate is 120 bpm and blood
pressure is 70/53, skin is cool/clammy. As the nurse you would?*
A. Continue to monitor the patient
B. Notify the MD
C. Obtain an EKG
D. Check the patient's blood glucose
B
A patient is taking Aspirin 325 mg PO by mouth daily. The patient is scheduled for surgery in a
week. What education do you provide the patient with before surgery?*
A. Educate the patient to take the scheduled dose of Aspirin the day of surgery to help prevent
blood clots
B. To hold his morning dose of Aspirin because the nurse will give it to him before surgery
C. None of the above are correct
D. The medication should be discontinued for 48 hours prior to the scheduled surgery date
D
You are observing your patient use the incentive spirometry. What demonstration by the patient
lets you know the patient understands how to use the device properly?*
A. The patient inhales slowly on the device and maintains the flow indicator between 600 to 900
level
B. The patient blows on the mouthpiece rapidly.
2024/2025 REAL EXAM GRADED A+
An adult male is scheduled for surgery and the nurse is assessing for risk factors. Which is the
following are the greatest risk factors?
1.) He is 5ft 4 in tall and weighs 125 lb
2.) He expressed a fear of pain in the post-op period.
3.) He is 5ft 4 in tall, weighs 360lb, and is diabetic.
4.) He expresses fear of the unknown.
3.)He is 5ft 4 in tall, weighs 360lb, and is diabetic
The nurse in an outclient department is interviewing an adult one week prior to her scheduled
elective surgery. In planning for the surgery, which of the following should the nurse include in
her teaching?
1.) The client will be able to return home alone following the surgery.
2.) Limitations of oral intake the day of the procedure.
3.) The laboratory studies ordered do not need to be done until after the surgery.
4.) The client should not take any of her routine medications the morning of the surgery.
2.) Instructions should be given to the client regarding limitations or oral intake to avoid nausea
and vomiting for anesthesia.
The nurse enters a woman's room to administer 10mg Valium PO, the ordered pre-op medication
for her hysterectomy. During the conversation, the client tells the nurse that she and her husband
are planning to have another child in the coming year. The best action for the nurse to take is
which of the following?
1.) Do not administer the pre-op medication. NOtify the nursing supervisor and the physician.
2.) Go ahead and administer the medication as ordered.
3.) Check to see if the client has signed a surgical consent.
4.)Send the client to the OR without the medication.
1.)no client should be administered the per-op med until the informed consent has been obtained.
Even if the consent form is signed, the nurse should withhold sedating meds because this client
clearly does not understand the planned procedure.
The nurse administers 10mg IM morphine as a pre-op medication, and then discovers that there
is no signed operative permit. The best action for the nurse to take is to:
,1.) Send the client to surgery as scheduled.
2.) notify the nursing supervisor, the OR, and the physician.
3.) cancel surgery immediately
4.) obtain the needed constent.
2.)is a narcotic, sedative, or tranquilizing drug has been administered before signing of the
consent, the drug's effects must be allowed to wear off before consent can be given.
An adult received atropine sulfate (Atropine) as a pre-op medication 30 minutes ago and is now
complaining of dry mouth and her pulse rate is higher than before the medication was
administered. The nurse's best interpretation of these findings is that:
1.) The client is having an allergic reaction to the drug.
2.) the client needs a higher dose of this drug
3.) this is a normal side effect of Atropine
4.) the client is anxious about the upcoming surgery.
3.) These are normal side effects of an anticholinergic drug; adverse side effects would include
ECG changes, constipation, and urinary retention.
An adult with COPD is scheduled for surgery and the physician has recommended an epidural
anesthetic. The nurse should know that general anesthesia was not recommended for this client
because:
1.)there is too high a risk for pressure sores to develop
2.) there is less effect on the respiratory system with epidural anesthesia.
3.) CNS control of the vascular constriction would be affected with general anesthesia.
4.) there is too high a risk of lacerations to the mouth, bruising of lips, and damage to teeth.
2.) Epidural anesthesia does not cause resp. depression, but general anesthesia can. especially in
a client with COPD.
A patient is now in the recovery room after having vaginal surgery. Due to the positioning of the
procedure, you would want to assess for what while the patient is in recovery?
A. Bowel Sounds
B. Dysrhythmia
C. Homan's Sign
D. Hemoglobin Level
C
After surgery your patient is semicomatose with vital signs within normal limits. As the nurse,
what position would be best for this patient?
A. Semi-Fowlers
B. Prone
C. Low-Fowlers
D. Side positioning preferably on the left side
,D
After surgery your patient starts to shiver uncontrollably. What nursing intervention would you
do FIRST?*
A. Apply warm blankets & continue oxygen as prescribed
B. Take the patient's rectal temperature
C. Page the doctor for further orders
D. Adjust the thermostat in the room
A
The nurse is monitoring the patient who is 24 hours post-opt from surgery. Which finding
requires intervention?*
A. BP 100/80
B. 24-hour urine output of 300 ml
C. Pain rating of 4 on 1-10 scale
D. Temperature of 99.3' F
B
A patient is 6 days post-opt from abdominal surgery. The patient is to be discharged later today.
The patient uses the call light and asks you to come to his room and look at his surgical site. On
arrival, you see that approximately 2 inches of internal organs are protruding through the
incision. What intervention would you NOT do?*
A. Put the patient in prone position with knees extended to put pressure on the site
B. Cover the wound with sterile normal saline dressing
C. Monitor for signs of shock
D. Notify the MD and administer as prescribed antiemetic to prevent vomiting
A
A patient reports he hasn't had a bowel movement or passed gas since surgery. On assessment,
you note the abdomen is distended and no bowel sounds are noted in the four quadrants. You
notify the MD. What non-invasive nursing interventions can you perform without a MD order?
A. Insert a nasogastric attached to intermittent suction
B. Administer IV fluids
C. Encourage ambulation, maintain NPO status, and monitor intake & output
D. Encourage at least 3000 ml of fluids per day
C
What is a potential postoperative concern regarding a patient who has already resumed a solid
diet?*
A. Failure to pass stool within 12 hours of eating solid foods
B. Failure to pass stool within 48 hours of eating solid foods
C. Passage of excessive flatus
D. Patient reports a decreased appetite
, B
A nurse is developing a care plan for a patient who is at risk for developing pneumonia after
surgery. Which of the following is not an appropriate nursing intervention?*
A. Encourage patient intake of 3000 ml/day of fluids if not contraindicated
B. Encourage patient to use the incentive spirometer device 10 times every 1-2 hours while
awake
C. Encourage early ambulation and patient to eat meals in beside chair
D. Repositioning every 3-4 hours
D
When assessing your patient who is post-opt, you notice that the patient's right calf vein feels
hard, cord-like, and is tender to the touch. The patient reports it is aching and painful. What
would NOT be an appropriate nursing intervention for this patient?*
A. Allow the patient to dangle the legs to help increase circulation and alleviate pain
B. Instruct the patient to not sit in one position for a long period of time
C. Elevate the extremity 30 degrees without allowing any pressure on affected area
D. Administer anticoagulants as ordered by MD
A
A patient is recovering from surgery. The patient is very restless, heart rate is 120 bpm and blood
pressure is 70/53, skin is cool/clammy. As the nurse you would?*
A. Continue to monitor the patient
B. Notify the MD
C. Obtain an EKG
D. Check the patient's blood glucose
B
A patient is taking Aspirin 325 mg PO by mouth daily. The patient is scheduled for surgery in a
week. What education do you provide the patient with before surgery?*
A. Educate the patient to take the scheduled dose of Aspirin the day of surgery to help prevent
blood clots
B. To hold his morning dose of Aspirin because the nurse will give it to him before surgery
C. None of the above are correct
D. The medication should be discontinued for 48 hours prior to the scheduled surgery date
D
You are observing your patient use the incentive spirometry. What demonstration by the patient
lets you know the patient understands how to use the device properly?*
A. The patient inhales slowly on the device and maintains the flow indicator between 600 to 900
level
B. The patient blows on the mouthpiece rapidly.
