NSG 300 Exam 3 (2026/2027) - Foundations of Nursing - Grand
Canyon University (GCU) - Complete Guide with & Answers -
47 Questions
This exam assesses advanced understanding of perioperative nursing concepts including preoperative assessment,
intraoperative sterile technique, postoperative complications, and evidence-based interventions. Questions
require synthesis of pathophysiology, pharmacology, and nursing standards. It contains 47 multiple-choice
questions, each with four distractors and a fully worked rationale that explains why the keyed answer is correct.
Content is organized into 10 focused sections: Perioperative Nursing Care, Fluid, Electrolyte, and Acid-Base
Balance, Intravenous Therapy and Blood Transfusion, Pain Management, Wound Care and Pressure Injuries,
Mobility and Immobility, Oxygenation and Respiratory Care, Nutrition and Elimination, Sensory Perception and
Sleep, End-of-Life Care. Targeted learning outcomes include: Analyze preoperative risk factors and implement
individualized nursing interventions.; Apply principles of sterile technique and surgical asepsis in the
intraoperative setting.; Evaluate postoperative complications and prioritize nursing actions based on clinical
presentation.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 2 hours, with a passing score of 85%. Aligned with This exam
aligns with AACN BSN Essentials and CCNE accreditation standards for baccalaureate nursing education.
Section 1: Perioperative Nursing Care (Questions 1-5)
1 During the preoperative assessment, a patient reports taking a daily dose
of 325 mg aspirin for primary prevention of cardiovascular events. The
surgical procedure is an elective laparoscopic cholecystectomy
scheduled in 48 hours. Which action best reflects current evidence-based
guidelines for perioperative antiplatelet management?
A) Continue aspirin throughout the perioperative period due to the low
risk of bleeding with laparoscopic surgery.
B) Discontinue aspirin 7-10 days before surgery and bridge with a
short-acting anticoagulant.
C) Consult the prescribing provider to weigh the thromboembolic risk
against the bleeding risk; consider continuing aspirin if the patient has a
drug-eluting stent.
D) Replace aspirin with a nonsteroidal anti-inflammatory drug (NSAID)
24 hours before surgery to reduce bleeding risk.
Answer: C
Rationale: Current guidelines recommend individualized decision-making
for aspirin continuation in the perioperative period, particularly for
,patients with coronary stents or high thromboembolic risk. Option C
reflects this nuanced approach. Option A is incorrect because aspirin
increases bleeding risk even in laparoscopic surgery. Option B is overly
aggressive for primary prevention. Option D is incorrect because NSAIDs
also increase bleeding risk and are not a recommended substitute.
2 A patient undergoing a total hip arthroplasty under general anesthesia
develops a sudden drop in end-tidal carbon dioxide (ETCO2) from 38 to
22 mm Hg, accompanied by hypotension (80/50 mm Hg) and oxygen
desaturation (SpO2 88%). The surgeon has just begun reaming the
femoral canal. Which complication should the perioperative nurse
suspect first?
A) Venous air embolism (VAE)
B) Malignant hyperthermia (MH)
C) Fat embolism syndrome (FES)
D) Anaphylactic reaction to the cement monomer
Answer: C
Rationale: The triad of sudden hypotension, hypoxia, and decreased
ETCO2 during femoral canal reaming in a hip arthroplasty is classic for
fat embolism syndrome. Fat globules enter the circulation, causing
pulmonary and systemic emboli. Option A (VAE) is more common in
sitting craniotomies and would show a different pattern. Option B (MH)
presents with hyperthermia, muscle rigidity, and increased ETCO2.
Option D (anaphylaxis) would involve bronchospasm, rash, and often
increased ETCO2 initially.
3 A circulating nurse is preparing the sterile field for a major abdominal
surgery. The surgical technologist accidentally touches the sterile drape
with an unsterile glove. The nurse should immediately:
A) Spray the contaminated area with an alcohol-based disinfectant and
allow it to dry.
B) Remove the drape and set up a new sterile field with completely new
sterile supplies.
C) Place a sterile towel over the contaminated area and continue the
setup.
, D) Change the glove and proceed, as the contamination is only on the
edge of the drape.
Answer: B
Rationale: Any break in sterility, even a touch by an unsterile glove to a
sterile drape, renders the entire sterile field contaminated. The only safe
action is to discard the drape and all items that came into contact with it,
and establish a new sterile field. Option A is incorrect because disinfection
does not restore sterility. Option C and D violate aseptic principles and
increase infection risk.
4 In the post-anesthesia care unit (PACU), a patient who underwent a
hemicolectomy under general anesthesia has a respiratory rate of 8
breaths/min, pinpoint pupils, and is difficult to arouse. The nurse notes a
history of chronic opioid use. Which intervention should the nurse
prioritize?
A) Administer naloxone 0.4 mg IV push immediately and repeat every
2-3 minutes until respiratory rate improves.
B) Administer naloxone 0.04 mg IV push and titrate to achieve a
respiratory rate > 12 breaths/min while preserving analgesia.
C) Apply high-flow oxygen via non-rebreather mask and stimulate the
patient to breathe deeply.
D) Prepare for endotracheal intubation and mechanical ventilation due to
opioid-induced respiratory depression.
Answer: B
Rationale: In a patient with chronic opioid use, acute reversal with
high-dose naloxone (option A) can precipitate severe withdrawal and pain,
potentially causing hypertension, tachycardia, and pulmonary edema.
Option B reflects the recommended low-dose titration to reverse
respiratory depression while maintaining pain control. Option C is
insufficient for significant respiratory depression. Option D is too
aggressive without first attempting pharmacological reversal.
Canyon University (GCU) - Complete Guide with & Answers -
47 Questions
This exam assesses advanced understanding of perioperative nursing concepts including preoperative assessment,
intraoperative sterile technique, postoperative complications, and evidence-based interventions. Questions
require synthesis of pathophysiology, pharmacology, and nursing standards. It contains 47 multiple-choice
questions, each with four distractors and a fully worked rationale that explains why the keyed answer is correct.
Content is organized into 10 focused sections: Perioperative Nursing Care, Fluid, Electrolyte, and Acid-Base
Balance, Intravenous Therapy and Blood Transfusion, Pain Management, Wound Care and Pressure Injuries,
Mobility and Immobility, Oxygenation and Respiratory Care, Nutrition and Elimination, Sensory Perception and
Sleep, End-of-Life Care. Targeted learning outcomes include: Analyze preoperative risk factors and implement
individualized nursing interventions.; Apply principles of sterile technique and surgical asepsis in the
intraoperative setting.; Evaluate postoperative complications and prioritize nursing actions based on clinical
presentation.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 2 hours, with a passing score of 85%. Aligned with This exam
aligns with AACN BSN Essentials and CCNE accreditation standards for baccalaureate nursing education.
Section 1: Perioperative Nursing Care (Questions 1-5)
1 During the preoperative assessment, a patient reports taking a daily dose
of 325 mg aspirin for primary prevention of cardiovascular events. The
surgical procedure is an elective laparoscopic cholecystectomy
scheduled in 48 hours. Which action best reflects current evidence-based
guidelines for perioperative antiplatelet management?
A) Continue aspirin throughout the perioperative period due to the low
risk of bleeding with laparoscopic surgery.
B) Discontinue aspirin 7-10 days before surgery and bridge with a
short-acting anticoagulant.
C) Consult the prescribing provider to weigh the thromboembolic risk
against the bleeding risk; consider continuing aspirin if the patient has a
drug-eluting stent.
D) Replace aspirin with a nonsteroidal anti-inflammatory drug (NSAID)
24 hours before surgery to reduce bleeding risk.
Answer: C
Rationale: Current guidelines recommend individualized decision-making
for aspirin continuation in the perioperative period, particularly for
,patients with coronary stents or high thromboembolic risk. Option C
reflects this nuanced approach. Option A is incorrect because aspirin
increases bleeding risk even in laparoscopic surgery. Option B is overly
aggressive for primary prevention. Option D is incorrect because NSAIDs
also increase bleeding risk and are not a recommended substitute.
2 A patient undergoing a total hip arthroplasty under general anesthesia
develops a sudden drop in end-tidal carbon dioxide (ETCO2) from 38 to
22 mm Hg, accompanied by hypotension (80/50 mm Hg) and oxygen
desaturation (SpO2 88%). The surgeon has just begun reaming the
femoral canal. Which complication should the perioperative nurse
suspect first?
A) Venous air embolism (VAE)
B) Malignant hyperthermia (MH)
C) Fat embolism syndrome (FES)
D) Anaphylactic reaction to the cement monomer
Answer: C
Rationale: The triad of sudden hypotension, hypoxia, and decreased
ETCO2 during femoral canal reaming in a hip arthroplasty is classic for
fat embolism syndrome. Fat globules enter the circulation, causing
pulmonary and systemic emboli. Option A (VAE) is more common in
sitting craniotomies and would show a different pattern. Option B (MH)
presents with hyperthermia, muscle rigidity, and increased ETCO2.
Option D (anaphylaxis) would involve bronchospasm, rash, and often
increased ETCO2 initially.
3 A circulating nurse is preparing the sterile field for a major abdominal
surgery. The surgical technologist accidentally touches the sterile drape
with an unsterile glove. The nurse should immediately:
A) Spray the contaminated area with an alcohol-based disinfectant and
allow it to dry.
B) Remove the drape and set up a new sterile field with completely new
sterile supplies.
C) Place a sterile towel over the contaminated area and continue the
setup.
, D) Change the glove and proceed, as the contamination is only on the
edge of the drape.
Answer: B
Rationale: Any break in sterility, even a touch by an unsterile glove to a
sterile drape, renders the entire sterile field contaminated. The only safe
action is to discard the drape and all items that came into contact with it,
and establish a new sterile field. Option A is incorrect because disinfection
does not restore sterility. Option C and D violate aseptic principles and
increase infection risk.
4 In the post-anesthesia care unit (PACU), a patient who underwent a
hemicolectomy under general anesthesia has a respiratory rate of 8
breaths/min, pinpoint pupils, and is difficult to arouse. The nurse notes a
history of chronic opioid use. Which intervention should the nurse
prioritize?
A) Administer naloxone 0.4 mg IV push immediately and repeat every
2-3 minutes until respiratory rate improves.
B) Administer naloxone 0.04 mg IV push and titrate to achieve a
respiratory rate > 12 breaths/min while preserving analgesia.
C) Apply high-flow oxygen via non-rebreather mask and stimulate the
patient to breathe deeply.
D) Prepare for endotracheal intubation and mechanical ventilation due to
opioid-induced respiratory depression.
Answer: B
Rationale: In a patient with chronic opioid use, acute reversal with
high-dose naloxone (option A) can precipitate severe withdrawal and pain,
potentially causing hypertension, tachycardia, and pulmonary edema.
Option B reflects the recommended low-dose titration to reverse
respiratory depression while maintaining pain control. Option C is
insufficient for significant respiratory depression. Option D is too
aggressive without first attempting pharmacological reversal.
