Med Surg: Exam 1-Pre, Intra, Post Surgical NCLEX Questions

A nurse is completing a preoperative assessment on a patient scheduled for abdominal surgery. Which finding should be reported to the surgeon immediately?

A. Patient reports stopping aspirin 7 days ago

B. Patient states they drank water 2 hours ago

C. Patient reports taking garlic supplements daily

D. Patient states they feel anxious about the surgery

C. Garlic supplements can increase bleeding risk and must be reported immediately.

Which nursing responsibility is priority during the immediate postoperative phase in the PACU?

A. Monitoring the surgical site for drainage

B. Assessing level of consciousness

C. Ensuring airway patency

D. Checking urinary output

C. Airway comes first in ABCs.

The nurse is teaching a patient about incentive spirometry use after surgery. Which statement indicates understanding?

A. "I will use it only if I feel short of breath."

B. "I should use it 10 times every hour while awake."

C. "I should exhale into the device as hard as I can."

D. "I only need to use it before bed."

B. Regular use prevents atelectasis and pneumonia.

A nurse is verifying informed consent for surgery. Which patient statement indicates the consent is valid?

A. "I took a sedative 20 minutes ago but I still understand."

B. "My doctor explained the risks and I had all my questions answered."

C. "I don't know why I'm having surgery, but I'll sign anyway."

D. "The nurse explained the procedure to me."

B. Consent must come from the provider, and the patient must understand before sedatives.

SATA: Which interventions are appropriate for reducing risk of postoperative deep vein thrombosis (DVT)?

A. Early ambulation

B. Incentive spirometry

C. Sequential compression devices

D. Low-dose anticoagulants

E. Repositioning every 2 hours

A, C, D, E

Incentive spirometry prevents respiratory complications, not DVT.

A patient in the PACU is restless and their oxygen saturation drops to 86%. What is the priority action?

A. Notify the anesthesiologist

B. Apply oxygen

C. Reassess in 15 minutes

D. Administer prescribed opioid for pain

B. Oxygen saturation below 90% requires immediate intervention.

Which task can be delegated to a UAP (unlicensed assistive personnel) for a postoperative patient?

A. Reinforcing patient teaching about coughing and deep breathing

B. Ambulating the patient for the first time after surgery

C. Obtaining vital signs every 15 minutes

D. Assessing pain level

C. Vital signs collection is within UAP role. Teaching, initial ambulation, and pain assessment require RN.

During the intraoperative phase, which responsibility belongs to the circulating nurse?

A. Maintaining sterility of the surgical field

B. Passing instruments to the surgeon

C. Documenting intraoperative care

D. Counting sponges and instruments

C. Circulating nurse manages the environment, documentation, and patient advocacy (not sterile field).

The nurse notes that a patient has a POSS (Pasero Opioid Sedation Scale) score of 3 after receiving IV morphine. Which is the correct action?

A. Continue opioid administration as ordered

B. Hold the opioid and notify the provider

C. Document and reassess in 4 hours

D. Give additional opioid if pain persists

B. A score of 3 = "frequently drowsy, drifts off during conversation" → unsafe for opioids.

A patient is 12 hours postoperative after abdominal surgery. Which finding requires immediate intervention?

A. Small amount of serosanguinous drainage on dressing

B. Absent bowel sounds in all four quadrants

C. Oxygen saturation of 88% on room air

D. Patient reports pain rated 6/10

C. Low O₂ saturation indicates respiratory compromise, which is life-threatening.

The nurse prepares to administer a preoperative sedative. Which action must be completed beforegiving the medication?

A. Ensure the patient has voided

B. Ensure the consent form is signed

C. Document the time of administration

D. Assess the patient's vital signs

B. Sedatives cannot be given until consent is signed and verified.

SATA: Which are appropriate patient teaching points before discharge after abdominal surgery?

A. Call the provider for fever >101°F

B. Avoid lifting heavy objects until cleared

C. Expect constipation for up to 2 weeks without intervention

D. Use incentive spirometer every 2 hours when awake

E. Contact the provider if incision is red, swollen, or draining

A, B, D, E. Constipation should be prevented with fluids, fiber, ambulation, stool softeners.

Patient is drowsy after receiving pre-op sedative. Which action is most important?

A. Ensure side rails are up.

B. Obtain consent for procedure.

C. Send patient to OR immediately.

D. Call family for belongings.

A — safety, because consent is no longer valid once sedative given

A patient has already received IV midazolam (a sedative) before surgery. The surgeon asks the nurse to bring the consent form for the patient to sign. What is the nurse's best response?

A. Ask the patient to sign since they are still awake.

B. Have a family member sign instead.

C. Inform the surgeon the patient cannot legally consent after sedation.

D. Sign the consent for the patient as a witness.

C. Consent must be obtained before sedation. Once sedated, the patient cannot legally consent because judgment is impaired. The nurse acts as an advocate.

During surgery, which task is the circulating nurse's responsibility?

A. Maintaining the sterile field.

B. Handing instruments to the surgeon.

C. Documenting the procedure and patient care.

D. Monitoring anesthesia administration.

C. The circulating nurse manages the environment, documents, and supports the team. Scrub nurse maintains sterility and handles instruments.

A nurse is caring for a patient under general anesthesia. Which finding is an early sign of malignant hyperthermia?

A. Rapid increase in temperature

B. Muscle rigidity

C. Tachycardia and increased CO₂ levels

D. Decreased urine output

C. Increased end-tidal CO₂ and tachycardia are early signs. Muscle rigidity may follow. Temperature rise is a late sign.

f malignant hyperthermia is suspected, which action should the nurse take first?

A. Notify the surgeon.

B. Administer dantrolene.

C. Increase room temperature.

D. Insert a urinary catheter.

B. Dantrolene is the antidote and must be given immediately to reverse muscle rigidity and hypermetabolism.

A patient is in the PACU after abdominal surgery. Which assessment requires immediate intervention?

A. O₂ saturation 88%

B. Blood pressure 90/60 mmHg

C. Drowsy but arousable

D. Incisional pain 8/10

A. Airway and breathing are the priority (ABCs). O₂ sat < 90% is critical. Low BP and pain are expected but not immediately life-threatening.

Which patient statement indicates atelectasis rather than pneumonia?

A. "I feel short of breath when I take deep breaths."

B. "I have a productive cough with green sputum."

C. "I feel feverish and chilled."

D. "I am coughing up thick mucus."

A. Atelectasis = shallow breathing, diminished breath sounds, SOB. Pneumonia = fever, sputum, productive cough.

A post-op patient is reluctant to get out of bed. What should the nurse emphasize as the priority intervention to prevent DVT?

A. Increase fluid intake.

B. Apply sequential compression devices.

C. Administer opioid analgesics.

D. Elevate the head of the bed.

B. SCDs promote venous return and prevent clot formation. Early ambulation is also key.

Which statement by a post-op patient requires further teaching?

A. "I should call my doctor if I have a fever above 101°F."

B. "If I notice redness or swelling at the incision site, I should report it."

C. "I should avoid coughing or deep breathing to protect my stitches."

D. "I need to eat foods high in protein and vitamin C to help healing."

C. Deep breathing and coughing prevent pneumonia/atelectasis. Patients should not avoid them.

A patient has received pre-op sedation and is drowsy. What is the nurse's priority action?

A. Ensure the side rails are up.

B. Have the patient sign the consent form.

C. Send the patient to the OR immediately.

D. Call the family to pick up belongings.

A.