SURGICAL (MEDICAL-SURGICAL)
EXAM QUESTIONS
1. A client arrives for preoperative teaching before an appendectomy. Which statement by
the client indicates the need for further teaching?
A. “I’ll avoid eating after midnight.”
B. “I should tell the nurse about any medications I take.”
C. “I can stop my anticoagulant the morning of surgery without telling anyone.”
D. “I’ll bring my hearing aid for use after surgery.”
Answer: C.
Rationale: Clients must inform staff before stopping anticoagulants; stopping without
instruction risks bleeding or clotting and requires provider guidance.
2. A postoperative client following abdominal surgery has a nasogastric (NG) tube to low
intermittent suction. The nurse notes decreased drainage and abdominal distention. What
is the nurse’s priority action?
A. Reposition the client.
B. Check for kinks or disconnection in tubing.
C. Irrigate the tube with 30 mL saline.
D. Notify the surgeon immediately.
Answer: B.
Rationale: Low drainage with distention suggests tube obstruction — first check tubing
for kinks or disconnection before more invasive steps.
3. A client with a Penrose drain complains of increasing pain and serosanguineous drainage.
The nurse notes the drain has pulled back 2 cm. What action is best?
A. Pull the drain out further.
B. Secure the drain and notify the surgeon.
C. Cut the drain shorter and re-dress.
D. Remove the drain completely.
Answer: B.
Rationale: If a drain has shifted, secure it and notify the surgeon; do not manipulate or
remove without provider order.
4. A postoperative client has respiratory rate 10, pulse 120, BP 90/58, and O₂ saturation
86% on room air. Which action is highest priority?
A. Encourage coughing and deep breathing.
B. Administer PRN opioid for pain.
C. Apply oxygen and elevate head of bed.
D. Obtain arterial blood gas.
Answer: C.
Rationale: Hypoxia and hypotension require immediate oxygenation and positioning to
improve oxygenation; diagnostics and other interventions follow.
5. A client with a newly placed urinary catheter after surgery has urine output 20 mL/hour
for 3 hours. Which action should the nurse take first?
A. Increase IV fluid rate.
, B. Irrigate the catheter with 30 mL sterile saline.
C. Check catheter tubing for kinks or obstruction.
D. Notify the surgeon.
Answer: C.
Rationale: Low output may be due to tubing obstruction — assess the catheter and
tubing before escalating fluids or calling provider.
6. A client one day post-op has a temperature of 38.6°C (101.5°F), increased white blood
cell count, and purulent drainage from the incision. Which finding is most consistent with
a superficial surgical site infection?
A. Elevated creatinine.
B. Purulent drainage and localized erythema.
C. New onset productive cough.
D. Fever without local signs.
Answer: B.
Rationale: Purulent drainage and erythema localized to incision indicate superficial
surgical site infection.
7. A client is receiving morphine PCA after a tibial fracture repair. The client is drowsy,
respirations 8/min, and O₂ saturation 90%. What should the nurse do first?
A. Give naloxone.
B. Decrease the PCA basal rate.
C. Stimulate the client and give oxygen.
D. Call the surgeon.
Answer: C.
Rationale: First ensure airway/oxygenation and stimulate; reversing agents or rate
adjustments follow assessment.
8. A client with a chest tube following thoracotomy has several sudden, loud, continuous
bubbling in the water seal chamber. What does this indicate?
A. Normal function.
B. Air leak in the system.
C. Occlusion of tube.
D. Lung re-expansion.
Answer: B.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak;
intermittent bubbling in the suction chamber is expected.
9. A postoperative client is experiencing sudden chest pain, dyspnea, and tachycardia.
Which condition should the nurse suspect first?
A. Atelectasis.
B. Pulmonary embolism.
C. Myocardial infarction.
D. Aspiration pneumonia.
Answer: B.
Rationale: Sudden dyspnea, pleuritic chest pain, and tachycardia postoperatively suggest
pulmonary embolism — immediate evaluation required.
10. A client scheduled for surgery asks whether herbal supplements matter. Which
instruction is best?
A. “You can continue them up to the morning of surgery.”
, B. “Stop all herbal supplements at least 2 weeks before surgery.”
C. “Only stop ginkgo biloba and St. John’s wort.”
D. “They improve anesthesia recovery.”
Answer: B.
Rationale: Many herbal supplements affect bleeding and anesthesia; stopping 1–2 weeks
before surgery is commonly recommended and must be discussed with provider.
11. A client with an ileostomy reports dark green output and cramping. Which is the best
nursing response?
A. Teach to restrict fluids.
B. Explain that green output is expected initially.
C. Encourage high-fiber foods.
D. Notify the surgeon immediately.
Answer: B.
Rationale: Early ileostomy output may be green due to bile; teach normal progression
and when to report high output or dehydration.
12. A client with a total hip replacement is being turned. The nurse should use which
precaution?
A. Allow adduction beyond midline.
B. Maintain abduction and avoid internal rotation.
C. Flex hip >90° for positioning.
D. Cross legs to provide comfort.
Answer: B.
Rationale: After hip replacement, avoid adduction, internal rotation, and flexion >90° to
prevent dislocation.
13. A postoperative client with progressive abdominal pain, distention, and high-pitched
bowel sounds likely has:
A. Paralytic ileus.
B. Small bowel obstruction.
C. Diverticulitis.
D. Peptic ulcer disease.
Answer: B.
Rationale: Distention, crampy pain, and high-pitched (tinkling) bowel sounds are classic
for small bowel obstruction.
14. A client is receiving heparin infusion after vascular surgery. The nurse notes platelets
dropped from 230k to 90k in 3 days. What is the priority action?
A. Increase heparin dose.
B. Stop heparin and notify provider for possible HIT.
C. Order platelet transfusion.
D. Continue heparin and recheck labs in 24 hours.
Answer: B.
Rationale: A drop >50% or to <100k within days suggests heparin-induced
thrombocytopenia — stop heparin and notify provider.
15. A postoperative client with a wound evisceration should be positioned how?
A. Supine with legs flat.
B. Trendelenburg with knees flexed.
C. High Fowler’s position.
EXAM QUESTIONS
1. A client arrives for preoperative teaching before an appendectomy. Which statement by
the client indicates the need for further teaching?
A. “I’ll avoid eating after midnight.”
B. “I should tell the nurse about any medications I take.”
C. “I can stop my anticoagulant the morning of surgery without telling anyone.”
D. “I’ll bring my hearing aid for use after surgery.”
Answer: C.
Rationale: Clients must inform staff before stopping anticoagulants; stopping without
instruction risks bleeding or clotting and requires provider guidance.
2. A postoperative client following abdominal surgery has a nasogastric (NG) tube to low
intermittent suction. The nurse notes decreased drainage and abdominal distention. What
is the nurse’s priority action?
A. Reposition the client.
B. Check for kinks or disconnection in tubing.
C. Irrigate the tube with 30 mL saline.
D. Notify the surgeon immediately.
Answer: B.
Rationale: Low drainage with distention suggests tube obstruction — first check tubing
for kinks or disconnection before more invasive steps.
3. A client with a Penrose drain complains of increasing pain and serosanguineous drainage.
The nurse notes the drain has pulled back 2 cm. What action is best?
A. Pull the drain out further.
B. Secure the drain and notify the surgeon.
C. Cut the drain shorter and re-dress.
D. Remove the drain completely.
Answer: B.
Rationale: If a drain has shifted, secure it and notify the surgeon; do not manipulate or
remove without provider order.
4. A postoperative client has respiratory rate 10, pulse 120, BP 90/58, and O₂ saturation
86% on room air. Which action is highest priority?
A. Encourage coughing and deep breathing.
B. Administer PRN opioid for pain.
C. Apply oxygen and elevate head of bed.
D. Obtain arterial blood gas.
Answer: C.
Rationale: Hypoxia and hypotension require immediate oxygenation and positioning to
improve oxygenation; diagnostics and other interventions follow.
5. A client with a newly placed urinary catheter after surgery has urine output 20 mL/hour
for 3 hours. Which action should the nurse take first?
A. Increase IV fluid rate.
, B. Irrigate the catheter with 30 mL sterile saline.
C. Check catheter tubing for kinks or obstruction.
D. Notify the surgeon.
Answer: C.
Rationale: Low output may be due to tubing obstruction — assess the catheter and
tubing before escalating fluids or calling provider.
6. A client one day post-op has a temperature of 38.6°C (101.5°F), increased white blood
cell count, and purulent drainage from the incision. Which finding is most consistent with
a superficial surgical site infection?
A. Elevated creatinine.
B. Purulent drainage and localized erythema.
C. New onset productive cough.
D. Fever without local signs.
Answer: B.
Rationale: Purulent drainage and erythema localized to incision indicate superficial
surgical site infection.
7. A client is receiving morphine PCA after a tibial fracture repair. The client is drowsy,
respirations 8/min, and O₂ saturation 90%. What should the nurse do first?
A. Give naloxone.
B. Decrease the PCA basal rate.
C. Stimulate the client and give oxygen.
D. Call the surgeon.
Answer: C.
Rationale: First ensure airway/oxygenation and stimulate; reversing agents or rate
adjustments follow assessment.
8. A client with a chest tube following thoracotomy has several sudden, loud, continuous
bubbling in the water seal chamber. What does this indicate?
A. Normal function.
B. Air leak in the system.
C. Occlusion of tube.
D. Lung re-expansion.
Answer: B.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak;
intermittent bubbling in the suction chamber is expected.
9. A postoperative client is experiencing sudden chest pain, dyspnea, and tachycardia.
Which condition should the nurse suspect first?
A. Atelectasis.
B. Pulmonary embolism.
C. Myocardial infarction.
D. Aspiration pneumonia.
Answer: B.
Rationale: Sudden dyspnea, pleuritic chest pain, and tachycardia postoperatively suggest
pulmonary embolism — immediate evaluation required.
10. A client scheduled for surgery asks whether herbal supplements matter. Which
instruction is best?
A. “You can continue them up to the morning of surgery.”
, B. “Stop all herbal supplements at least 2 weeks before surgery.”
C. “Only stop ginkgo biloba and St. John’s wort.”
D. “They improve anesthesia recovery.”
Answer: B.
Rationale: Many herbal supplements affect bleeding and anesthesia; stopping 1–2 weeks
before surgery is commonly recommended and must be discussed with provider.
11. A client with an ileostomy reports dark green output and cramping. Which is the best
nursing response?
A. Teach to restrict fluids.
B. Explain that green output is expected initially.
C. Encourage high-fiber foods.
D. Notify the surgeon immediately.
Answer: B.
Rationale: Early ileostomy output may be green due to bile; teach normal progression
and when to report high output or dehydration.
12. A client with a total hip replacement is being turned. The nurse should use which
precaution?
A. Allow adduction beyond midline.
B. Maintain abduction and avoid internal rotation.
C. Flex hip >90° for positioning.
D. Cross legs to provide comfort.
Answer: B.
Rationale: After hip replacement, avoid adduction, internal rotation, and flexion >90° to
prevent dislocation.
13. A postoperative client with progressive abdominal pain, distention, and high-pitched
bowel sounds likely has:
A. Paralytic ileus.
B. Small bowel obstruction.
C. Diverticulitis.
D. Peptic ulcer disease.
Answer: B.
Rationale: Distention, crampy pain, and high-pitched (tinkling) bowel sounds are classic
for small bowel obstruction.
14. A client is receiving heparin infusion after vascular surgery. The nurse notes platelets
dropped from 230k to 90k in 3 days. What is the priority action?
A. Increase heparin dose.
B. Stop heparin and notify provider for possible HIT.
C. Order platelet transfusion.
D. Continue heparin and recheck labs in 24 hours.
Answer: B.
Rationale: A drop >50% or to <100k within days suggests heparin-induced
thrombocytopenia — stop heparin and notify provider.
15. A postoperative client with a wound evisceration should be positioned how?
A. Supine with legs flat.
B. Trendelenburg with knees flexed.
C. High Fowler’s position.
